Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | K7757 | TX |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | K7757 | TX |
NPI | 1053326835 |
---|---|
Provider Name | Jeffrey M Hantes |
First Address | Fort Worth, TX 76104 |
Second Address | Fort Worth, TX 76104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 29/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159031701 | (05) | TX |
159031702 | (05) | TX |
159031703 | (05) | TX |
159031704 | (05) | TX |
8A8699 | BCBS (01) | TX |
H57290 | (02) | TX |
P00050892 | RAILROAD MEDICARE PIN (01) | TX |