MEDICARE: JILL GRAMER DO PA

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1578884029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JILL GRAMER DO PA

Provider Business Mailing Address
First Line	:	6312 AZLE AVE STE 200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-2442
Country	:	US
Telephone Number	:	682-841-1056
Fax Number	:	682-841-1161

Provider Business Practice Location Address
First Line	:	6312 AZLE AVE STE 200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-2442
Country	:	US
Telephone Number	:	682-841-1056
Fax Number	:	682-841-1161

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JILL GRAMER
Credential	:	DO
Telephone Number	:	817-441-9769

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	09/08/2023

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Directions to “JILL GRAMER DO PA ” Practice Location

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