Provider Demographics
NPI:1295968758
Name:DYNAMIC RPA HEALTHCARE PC
Entity type:Organization
Organization Name:DYNAMIC RPA HEALTHCARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:INEAMA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:817-294-9600
Mailing Address - Street 1:6901 MCCART AVE
Mailing Address - Street 2:200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-6377
Mailing Address - Country:US
Mailing Address - Phone:817-294-9600
Mailing Address - Fax:817-294-9611
Practice Address - Street 1:6901 MCCART AVE
Practice Address - Street 2:200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-6377
Practice Address - Country:US
Practice Address - Phone:817-294-9600
Practice Address - Fax:817-294-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05609363AM0700X, 363A00000X
TXD6175207LP2900X, 208800000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05609OtherPA LICENSE
TX1063601300OtherNPI