Provider Demographics
NPI:1104096999
Name:JERRY F GURKOFF, D. O. P.A.
Entity type:Organization
Organization Name:JERRY F GURKOFF, D. O. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:F
Authorized Official - Last Name:GURKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-641-2661
Mailing Address - Street 1:2801 OSLER DR STE 222
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1060
Mailing Address - Country:US
Mailing Address - Phone:972-641-2661
Mailing Address - Fax:972-647-0639
Practice Address - Street 1:2801 OSLER DR STE 222
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1060
Practice Address - Country:US
Practice Address - Phone:972-641-2661
Practice Address - Fax:972-647-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00RU26OtherBLUE CROSS BLUE SHIELD
TX=========OtherHUMANA MILITARY
TX00RU26Medicare PIN
TX=========OtherHUMANA MILITARY
TX0918010001Medicare NSC