NPIMap

Organization Active NPI

Jerry T. Davis D.O.,P.a.

  • Family Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1215217229
Registry record updated Oct 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
F9351 Issued in TX
Legal business name
JERRY T. DAVIS D.O.,P.A.
Practice address
6302 Jacksboro Hwy Ste a
Fort Worth, TX 76135-3607
Phone
(817) 237-8273
Fax
(817) 237-0374
NPI assigned
Aug 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Glenda Wright
Title
Manager
Phone
(817) 237-8273

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X F9351 TX Primary

Addresses

Primary practice location

6302 Jacksboro Hwy Ste a
Fort Worth, TX 76135-3607

Mailing address

6302 Jacksboro Hwy Ste a
Fort Worth, TX 76135-3607
Phone (817) 237-8273

Other names 1

  • Lake Worth Minor Emergency Other name

National Provider Directory

National Provider Directory

Locations

6302 Lake Worth Blvd
Ste A
Lake Worth, TX 76135

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318809600000",
    "number": "1215217229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6302 JACKSBORO HWY STE A",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761353607",
            "telephone_number": "817-237-8273",
            "fax_number": "817-237-0374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6302 JACKSBORO HWY STE A",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761353607",
            "telephone_number": "817-237-8273",
            "fax_number": "817-237-0374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY T. DAVIS D.O.,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-22",
        "last_updated": "2011-10-17",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "GLENDA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "817-237-8273",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "F9351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Worth Minor Emergency",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.