Healthcare Provider Details

I. General information

NPI: 1073598199
Provider Name (Legal Business Name): JIMMY W DAILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 S BUFFALO ST
CANTON TX
75103-2304
US

IV. Provider business mailing address

PO BOX 788
CANTON TX
75103-0788
US

V. Phone/Fax

Practice location:
  • Phone: 903-567-1910
  • Fax: 903-567-1940
Mailing address:
  • Phone: 903-567-1910
  • Fax: 903-567-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK3567
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: