Provider Demographics
NPI:1184690810
Name:JETT, GARY KIMBLE (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:KIMBLE
Last Name:JETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4716 ALLIANCE BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5371
Mailing Address - Country:US
Mailing Address - Phone:469-800-6200
Mailing Address - Fax:469-800-6210
Practice Address - Street 1:4716 ALLIANCE BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5371
Practice Address - Country:US
Practice Address - Phone:469-800-6200
Practice Address - Fax:469-800-6210
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF1681208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0178010801Medicaid
TXB73054Medicare UPIN
TX8B8730Medicare ID - Type Unspecified