Provider Demographics
NPI:1265481600
Name:JARYGA, GREGORY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:JARYGA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7100 OAKMONT BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3911
Mailing Address - Country:US
Mailing Address - Phone:817-346-7481
Mailing Address - Fax:817-346-7908
Practice Address - Street 1:7100 OAKMONT BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3911
Practice Address - Country:US
Practice Address - Phone:817-346-7481
Practice Address - Fax:817-346-7908
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX0983213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00823317OtherGROUP MEMEBER INDIVIDUAL RRM PTAN #
TXP00823317OtherGROUP MEMEBER INDIVIDUAL RRM PTAN #
TX00DC35Medicare PIN
TX5429550001Medicare NSC