Provider Demographics
NPI:1053326835
Name:HANTES, JEFFREY M (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:HANTES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 HEMPHILL ST., SUITE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-731-3936
Mailing Address - Fax:817-782-0206
Practice Address - Street 1:1327 HEMPHILL ST., SUITE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-731-3936
Practice Address - Fax:817-782-0206
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7757207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159031703Medicaid
TX8A8699OtherBCBS
TX159031701Medicaid
TX159031702Medicaid
TXP00050892OtherRAILROAD MEDICARE PIN
TX159031704Medicaid
TX8A8699OtherBCBS
TXP00050892OtherRAILROAD MEDICARE PIN
TX159031701Medicaid
TX8L1570Medicare PIN
TX8A8699Medicare PIN