Basic Information
| Provider Information | |||||||||
| NPI: | 1184739534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAMBRO | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 COOPER ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828856299 | ||||||||
| FaxNumber: | 6828851090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 04/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0214X | H3012 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
ID Information
| ID | Type | State | Issuer | Description | 00257T | 01 | TX | MEDICARE GROUP | OTHER | 140442852 | 01 | TX | MEDICAID GROUP | OTHER | 150220508 | 01 | TX | MEDICAID GROUP | OTHER | 4389790 | 01 | TX | AETNA PIN | OTHER | 89V241 | 01 | TX | BCBSTX IND PIN | OTHER | 1750369203 | 01 | GRP NPI NUMBER | OTHER | 00U87Z | 01 | TX | MEDICARE GROUP | OTHER | 1640378 | 01 | TX | FIRSTHEALTH PIN | OTHER | 00U87Z | 01 | TX | BCBSTX GRP PIN | OTHER | 10029167 | 01 | TX | AMERIGROUP PIN | OTHER | 107958 | 01 | TX | SUPERIOR PIN | OTHER | 127419309 | 01 | TX | CSHCN | OTHER | 137345810 | 01 | TX | CSHCN GROUP | OTHER | 3064727 | 01 | TX | CIGNA PIN | OTHER | 127419310 | 05 | TX | MEDICAID | 127419311 | 01 | TX | CSHCN | OTHER | 1393065 | 01 | TX | UHC PIN | OTHER | 150220509 | 01 | TX | CSHCN GROUP | OTHER | 111200101 | 01 | TX | FIRSTCARE PIN | OTHER | 127419308 | 05 | TX | MEDICAID |