Organization
BOAT CLUB MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY THOMAS DAVIS DO (PROVIDER/OWNER)
(817) 917-2630
Entity
Organization
Contact information
Practice address
3963 BOAT CLUB RD, FT WORTH, TX 76135-3202
(817) 917-2630
Mailing address
3963 BOAT CLUB RD, FT WORTH, TX 76135-3202
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
F9351
TX
Other
Enumeration date
04/06/2015
Last updated
04/06/2015
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