Boat Club Medical

NPI #1720473846 in Ft Worth, Texas

Provider Information

NPI Number: 1720473846
Entity Type: Organization
Organization Name: Boat Club Medical
Primary Specialty: Specialist
Enumeration Date: Apr 6, 2015
Last Updated: Apr 6, 2015

Practice Location

Address: 3963 BOAT CLUB RD
City: Ft Worth
State: Texas
ZIP Code: 76135-3202
Phone: (817) 917-2630

Authorized Official

Name: JERRY THOMAS DAVIS, DO
Title: PROVIDER/OWNER
Phone: (817) 917-2630

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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