Individual
JISHA JACOB GEORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2733
(682) 885-1475
(682) 885-7520
Mailing address
PO BOX 99371, FORT WORTH, TX 76199-0371
(682) 885-1855
(682) 885-7347
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA08461
TX
Other
Enumeration date
08/16/2013
Last updated
09/24/2013
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