Provider Demographics
NPI:1154622678
Name:THERESA D. STRETCH MD, PA
Entity type:Organization
Organization Name:THERESA D. STRETCH MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:DELEON
Authorized Official - Last Name:STRETCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-635-6363
Mailing Address - Street 1:1806 W PLEASANT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4530
Mailing Address - Country:US
Mailing Address - Phone:817-635-6363
Mailing Address - Fax:817-635-6362
Practice Address - Street 1:1806 W PLEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4530
Practice Address - Country:US
Practice Address - Phone:817-635-6363
Practice Address - Fax:817-635-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6692207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CQ845OtherBCBS