Individual
JEREMY THOMAS DIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6316 PRECINCT LINE RD, HURST, TX 76054-2766
(817) 605-2525
Mailing address
1512 TEASLEY LN, DENTON, TX 76205-7282
(940) 382-0980
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
TX
Other
Enumeration date
06/26/2013
Last updated
11/08/2022
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