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General NPI Number Information
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NPI Number | 1962891275
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Entity Type | Organization
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Legal Business Name | GRAYSON DIGESTIVE DISEASE CONSULTANTS
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Dates
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Enumeration Date | 01/10/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 300 N HIGHLAND AVE STE 105
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City | SHERMAN
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State | TX
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Zip | 75092-7315
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Country | US
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Telephone | 903-364-4525
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Fax | 903-617-5467
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Provider Business Mailing Address
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Address Line | 300 N HIGHLAND AVE STE 105
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City | SHERMAN
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State | TX
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Zip | 75092-7315
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Country | US
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Telephone | 903-364-4525
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Fax | 903-617-5467
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Authorized Official
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Title or Position | GASTROENTEROLOGIST
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Name | DR. JERMAINE CLARKE
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Credential | D.O.
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Telephone | 903-364-4525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | P2971
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License Number State | TX
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