Provider Demographics
NPI:1255341004
Name:NAFTALIS, JEROME MELVIN (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:MELVIN
Last Name:NAFTALIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 HARRY HINES BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6233
Mailing Address - Country:US
Mailing Address - Phone:214-879-0003
Mailing Address - Fax:214-879-0016
Practice Address - Street 1:5959 HARRY HINES BLVD STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6233
Practice Address - Country:US
Practice Address - Phone:214-879-0003
Practice Address - Fax:214-879-0016
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C692Medicare ID - Type Unspecified
TXB25074Medicare UPIN