MEDICARE: DR. JAYSON DAVID AYDELOTTE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0102X	Surgical Critical Care Physician	N8483	TX
2	208600000X	Surgery Physician	MD036265	DC
3	2086S0127X	Trauma Surgery Physician	MD036265	DC
4	2086S0102X	Surgical Critical Care Physician	MD036265	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	281458402	OTHER	TX	CSHCN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063493039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYSON DAVID AYDELOTTE M.D.

Provider Business Mailing Address
First Line	:	1500 RED RIVER ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1918
Country	:	US
Telephone Number	:	512-324-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 TRINITY ST STE 704F
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78712-1765
Country	:	US
Telephone Number	:	512-324-7873
Fax Number	:	512-380-7503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	10/08/2025

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Directions to “ DR. JAYSON DAVID AYDELOTTE M.D.” Practice Location

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