Provider Demographics
NPI:1548367766
Name:RAPHA MEDICAL CARE, PA
Entity type:Organization
Organization Name:RAPHA MEDICAL CARE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERGUS
Authorized Official - Middle Name:T
Authorized Official - Last Name:AKWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:682-551-6709
Mailing Address - Street 1:6901 MCCART AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-6377
Mailing Address - Country:US
Mailing Address - Phone:682-551-6709
Mailing Address - Fax:
Practice Address - Street 1:6901 MCCART AVE
Practice Address - Street 2:STE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-6377
Practice Address - Country:US
Practice Address - Phone:682-551-6709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X850Medicare PIN