MEDICARE: JEFFREY M HANTES DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	K7757	TX
2	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	K7757	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00050892	OTHER	TX	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8A8699	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053326835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY M HANTES DO

Provider Business Mailing Address
First Line	:	1327 HEMPHILL ST., SUITE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104
Country	:	US
Telephone Number	:	817-731-3936
Fax Number	:	817-782-0206

Provider Business Practice Location Address
First Line	:	1327 HEMPHILL ST., SUITE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104
Country	:	US
Telephone Number	:	817-731-3936
Fax Number	:	817-782-0206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	11/29/2016

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Directions to “ JEFFREY M HANTES DO” Practice Location

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