Individual
DR. JEREMY PATRICK PARCELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2975 E BROAD ST STE 200, MANSFIELD, TX 76063-9147
(682) 518-8619
(682) 518-8195
Mailing address
P.O. BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 378-3699
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
6847
NE
208600000X
Surgery Physician
Primary
P7967
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
332557301
—
TX
01
—
3870853755
MYUTMB 3870853755-COMMERCIAL NUMBER
—
01
—
6847
TEMPORARY EDUCATION PERMIT
NE
01
—
P7967
MEDICAL LICENSE
TX
Enumeration date
06/14/2007
Last updated
11/04/2016
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