Healthcare Provider Details

I. General information

NPI: 1578884029
Provider Name (Legal Business Name): JILL GRAMER DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6312 AZLE AVE STE 200
FORT WORTH TX
76135-2442
US

IV. Provider business mailing address

6312 AZLE AVE STE 200
FORT WORTH TX
76135-2442
US

V. Phone/Fax

Practice location:
  • Phone: 682-841-1056
  • Fax: 682-841-1161
Mailing address:
  • Phone: 682-841-1056
  • Fax: 682-841-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL GRAMER
Title or Position: PRESIDENT
Credential: DO
Phone: 817-441-9769