Provider Demographics
NPI:1801486568
Name:BARRYFOSWALTMD PA
Entity type:Organization
Organization Name:BARRYFOSWALTMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSWALT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-536-9600
Mailing Address - Street 1:5668 EDWARDS RANCH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109
Mailing Address - Country:US
Mailing Address - Phone:817-536-9600
Mailing Address - Fax:817-677-9698
Practice Address - Street 1:5668 EDWARDS RANCH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107
Practice Address - Country:US
Practice Address - Phone:817-536-9600
Practice Address - Fax:817-677-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty