MEDICARE: JEFFREY S FINE MD

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	174400000X	Specialist	018765	LA
2	207RG0100X	Gastroenterology Physician	M6131	TX

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649272816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY S FINE MD

Provider Business Mailing Address
First Line	:	PO BOX 986
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-0986
Country	:	US
Telephone Number	:	817-571-8181
Fax Number	:	817-510-1217

Provider Business Practice Location Address
First Line	:	6750 N MACARTHUR BLVD STE 300
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039
Country	:	US
Telephone Number	:	972-253-4205
Fax Number	:	972-401-0458

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/07/2018

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Directions to “ JEFFREY S FINE MD” Practice Location

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