Provider Demographics
NPI:1285884809
Name:GORDON G. MCWATT, D.O., P.A.
Entity type:Organization
Organization Name:GORDON G. MCWATT, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCWATT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-457-9850
Mailing Address - Street 1:5601 BRIDGE ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-2384
Mailing Address - Country:US
Mailing Address - Phone:817-457-9850
Mailing Address - Fax:817-287-0001
Practice Address - Street 1:5601 BRIDGE ST
Practice Address - Street 2:SUITE 500
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2384
Practice Address - Country:US
Practice Address - Phone:817-457-9850
Practice Address - Fax:817-287-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6589261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine