Provider Demographics
NPI:1447229224
Name:GRAMER, JILL A (DO)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:GRAMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6312 AZLE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-2442
Mailing Address - Country:US
Mailing Address - Phone:682-841-1056
Mailing Address - Fax:682-841-1161
Practice Address - Street 1:6312 AZLE AVE # 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-2442
Practice Address - Country:US
Practice Address - Phone:682-841-1056
Practice Address - Fax:682-841-1161
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK3212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080163271OtherRAILROAD MEDICARE
TX847577OtherBCBS
TX104213702Medicaid
TX847577Medicare PIN
TX080163271OtherRAILROAD MEDICARE