Individual ProviderJoseph Nathan LiddleFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1500 S Main St, Fort Worth, TX 76104-4917(817) 702-1100(801) 691-6437PECOS EnrollmentBased on the most recent information from CMS, provider Joseph Nathan Liddle does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1184328403Provider TypeIndividualFull NameLiddle, Joseph NathanCredentialMDGenderMaleSole ProprietorNoEnumeration Date3/29/2023Last Updated4/19/2025Contact InformationPractice LocationPractice Address1500 S Main St, Fort Worth, TX 76104-4917Phone(817) 702-1100FaxUnlisted FaxMailing LocationMailing Address520 Samuels Ave Apt 9204, Fort Worth, TX 76102-8635Phone(801) 691-6437FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseV3367TexasCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer