Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | L9835 | TX |
Y | 207RP1001X | Pulmonary Disease | L9835 | TX |
NPI | 1053313882 |
---|---|
Provider Name | Dr. Kwaku A Osafo-Mensah |
First Address | Fort Worth, TX 76116-0920 |
Second Address | Fort Worth, TX 76116-0921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 17/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
173863501 | (05) | TX |
H39151 | (02) |