Provider Demographics
NPI:1902240492
Name:DO, TAI (MD)
Entity type:Individual
Prefix:DR
First Name:TAI
Middle Name:
Last Name:DO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 8TH AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2602
Mailing Address - Country:US
Mailing Address - Phone:682-224-3748
Mailing Address - Fax:682-841-0039
Practice Address - Street 1:515 W MAYFIELD RD STE 409
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2085
Practice Address - Country:US
Practice Address - Phone:682-224-3748
Practice Address - Fax:682-841-0039
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6996208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery