Provider Demographics
NPI:1386965234
Name:MCGILVRAY, DANIEL JETTON (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JETTON
Last Name:MCGILVRAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 LOCKE AVE STE 315
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5747
Mailing Address - Country:US
Mailing Address - Phone:817-336-1189
Mailing Address - Fax:
Practice Address - Street 1:1320 HEMPHILL ST STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4716
Practice Address - Country:US
Practice Address - Phone:817-336-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3773207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine