MEDICARE: DR. JERRY THOMAS DAVIS 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	207Q00000X	Family Medicine Physician	F9351	TX

General Provider Information

NPI Number	:	1821179003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY THOMAS DAVIS DO

Provider Business Mailing Address
First Line	:	3963 BOAT CLUB RD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76135-3202
Country	:	US
Telephone Number	:	817-237-8273
Fax Number	:	817-237-0374

Provider Business Practice Location Address
First Line	:	6302 A JACKSBORO HWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3602
Country	:	US
Telephone Number	:	817-237-8273
Fax Number	:	817-237-0374

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/23/2016

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