SAMUEL COLERIDGE

FORT WORTH, TX
NPI1013986058
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: TX  J2546)
Enumeration Date2006-03-14
Last Update Date2007-07-08
Business Address
-- SAMUEL COLERIDGE
2106 N MAIN ST
FORT WORTH, TX 76106-8511
Phone number: 817-625-4254
Mailing Address
-- SAMUEL COLERIDGE
3500 CAMP BOWIE BLVD
FORT WORTH, TX 76107-2644
Phone number: 817-735-0170
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