Healthcare Provider Details

I. General information

NPI: 1053326835
Provider Name (Legal Business Name): JEFFREY M HANTES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 HEMPHILL ST., SUITE 100
FORT WORTH TX
76104
US

IV. Provider business mailing address

1327 HEMPHILL ST., SUITE 100
FORT WORTH TX
76104
US

V. Phone/Fax

Practice location:
  • Phone: 817-731-3936
  • Fax: 817-782-0206
Mailing address:
  • Phone: 817-731-3936
  • Fax: 817-782-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberK7757
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberK7757
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: