Provider Demographics
NPI:1295789949
Name:AWTREY, JILL DANETTE (DO)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:DANETTE
Last Name:AWTREY
Suffix:
Gender:F
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:PO BOX 6217
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75461
Mailing Address - Country:US
Mailing Address - Phone:903-782-9500
Mailing Address - Fax:903-782-9550
Practice Address - Street 1:2850 LEWIS LN
Practice Address - Street 2:#109
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-2019
Practice Address - Country:US
Practice Address - Phone:903-782-9500
Practice Address - Fax:903-782-9550
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL42332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3017OtherOUT OF STATE LICENSE NUMB
G01604Medicare UPIN
OK3017OtherOUT OF STATE LICENSE NUMB