MEDICARE: DR. GREGORY A JARYGA DPM

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	213E00000X	Podiatrist	0983	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00823317	OTHER	TX	GROUP MEMEBER INDIVIDUAL RRM PTAN #

General Provider Information

NPI Number	:	1265481600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY A JARYGA DPM

Provider Business Mailing Address
First Line	:	7100 OAKMONT BLVD
Second Line	:	SUITE 208
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3911
Country	:	US
Telephone Number	:	817-346-7481
Fax Number	:	817-346-7908

Provider Business Practice Location Address
First Line	:	7100 OAKMONT BLVD
Second Line	:	SUITE 208
City	:	FT WORTH
State	:	TX
Zip	:	76132-3911
Country	:	US
Telephone Number	:	817-346-7481
Fax Number	:	817-346-7908

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	06/28/2011

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