MEDICARE: DR. JEREMY PATRICK PARCELLS 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	208600000X	Surgery Physician	6847	NE
2	208600000X	Surgery Physician	P7967	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	6847	OTHER	NE	TEMPORARY EDUCATION PERMIT
3	3870853755	OTHER		MYUTMB 3870853755-COMMERCIAL NUMBER
4	P7967	OTHER	TX	MEDICAL LICENSE

General Provider Information

NPI Number	:	1831393412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY PATRICK PARCELLS MD

Provider Business Mailing Address
First Line	:	P.O. BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-378-3699

Provider Business Practice Location Address
First Line	:	2975 E BROAD ST STE 200
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-9147
Country	:	US
Telephone Number	:	682-518-8619
Fax Number	:	682-518-8195

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	11/04/2016

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