Provider Demographics
NPI:1346745783
Name:INGLIMA, VINCENT J (DPM)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:J
Last Name:INGLIMA
Suffix:
Gender:M
Credentials:DPM
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2901 ACME BRICK PLZ
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4124
Mailing Address - Country:US
Mailing Address - Phone:817-529-1900
Mailing Address - Fax:817-529-1910
Practice Address - Street 1:1000 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3834
Practice Address - Country:US
Practice Address - Phone:940-626-2410
Practice Address - Fax:940-626-2411
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX3084213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX425677801Medicaid