MEDICARE: DR. JERRON C HILL

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	207L00000X	Anesthesiology Physician	L4969	TX

General Provider Information

NPI Number	:	1104219732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JERRON C HILL

Provider Business Mailing Address
First Line	:	PO BOX 702097
Second Line	:	SUITE 485
City	:	DALLAS
State	:	TX
Zip	:	75370-2097
Country	:	US
Telephone Number	:	972-980-0500
Fax Number	:	972-980-0503

Provider Business Practice Location Address
First Line	:	4101 MCEWEN RD
Second Line	:	SUITE 485
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-5112
Country	:	US
Telephone Number	:	972-980-0500
Fax Number	:	972-980-0503

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JERRON CARLYLE HILL
Credential	:	M.D.
Telephone Number	:	214-437-4801

Provider Enumeration Date	:	03/06/2015
Last Update Date	:	06/01/2015

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