Provider Demographics
NPI:1831393412
Name:PARCELLS, JEREMY PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:PATRICK
Last Name:PARCELLS
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:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-378-3699
Practice Address - Street 1:2975 E BROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9147
Practice Address - Country:US
Practice Address - Phone:682-518-8619
Practice Address - Fax:682-518-8195
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6847208600000X
TXP7967208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX332557301Medicaid
NE6847OtherTEMPORARY EDUCATION PERMIT
3870853755OtherMYUTMB 3870853755-COMMERCIAL NUMBER
TXP7967OtherMEDICAL LICENSE
TX332557301Medicaid