Provider Demographics
NPI:1306946934
Name:BECKWITH, JAY (DO)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:BECKWITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1051 HASKELL ST
Mailing Address - Street 2:208
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2649
Mailing Address - Country:US
Mailing Address - Phone:817-737-3166
Mailing Address - Fax:817-737-4881
Practice Address - Street 1:1051 HASKELL ST
Practice Address - Street 2:208
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2649
Practice Address - Country:US
Practice Address - Phone:817-737-3166
Practice Address - Fax:817-737-4881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4711207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88K621Medicare PIN
TXA65370Medicare UPIN