Individual
DR. JAY LEE FIERKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0312
(817) 317-7033
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0312
(817) 317-7033
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
E5750
TX
2085N0700X
Neuroradiology Physician
E5750
TX
2085N0904X
Nuclear Radiology Physician
E5750
TX
2085P0229X
Pediatric Radiology Physician
E5750
TX
2085R0202X
Diagnostic Radiology Physician
Primary
E5750
TX
2085R0204X
Vascular & Interventional Radiology Physician
E5750
TX
2085U0001X
Diagnostic Ultrasound Physician
E5750
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132546605
—
TX
01
—
E5750
TX PHYSICIANS PERMIT
TX
Enumeration date
05/12/2006
Last updated
01/27/2014
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