Provider Demographics
NPI:1699522219
Name:BEDRICH, RENE ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:ELIZABETH
Last Name:BEDRICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RENE
Other - Middle Name:ELIZABETH
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7528 NOBLE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-1731
Mailing Address - Country:US
Mailing Address - Phone:817-372-5901
Mailing Address - Fax:
Practice Address - Street 1:727 W BAILEY BOSWELL RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1011
Practice Address - Country:US
Practice Address - Phone:682-312-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17932207P00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine