MEDICARE: JERRY A MCNAMEE R. EPT, CNIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1780721241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY A MCNAMEE R. EPT, CNIM

Provider Business Mailing Address
First Line	:	4100 W 15TH ST
Second Line	:	SUITE 208
City	:	PLANO
State	:	TX
Zip	:	75093-5801
Country	:	US
Telephone Number	:	972-985-0498
Fax Number	:	972-612-1626

Provider Business Practice Location Address
First Line	:	4100 W 15TH ST
Second Line	:	SUITE 208
City	:	PLANO
State	:	TX
Zip	:	75093-5801
Country	:	US
Telephone Number	:	972-985-0498
Fax Number	:	972-612-1626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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