Healthcare Provider Details

I. General information

NPI: 1730418443
Provider Name (Legal Business Name): JAIME GARAY P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 MERIT DR STE 1610
DALLAS TX
75251-2204
US

IV. Provider business mailing address

12221 MERIT DR STE 1610
DALLAS TX
75251-2204
US

V. Phone/Fax

Practice location:
  • Phone: 214-217-1911
  • Fax: 214-217-1912
Mailing address:
  • Phone: 214-217-1911
  • Fax: 214-217-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA06546
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: