Provider Demographics
NPI:1710035324
Name:TENNANT, JERALD LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:LEE
Last Name:TENNANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JERRY
Other - Middle Name:LEE
Other - Last Name:TENNANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5601 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2606
Mailing Address - Country:US
Mailing Address - Phone:972-580-1156
Mailing Address - Fax:
Practice Address - Street 1:5601 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2606
Practice Address - Country:US
Practice Address - Phone:972-580-1156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1830207W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice