MEDICARE: JENNIFER MARSHALL DRISKELL MD

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	207Q00000X	Family Medicine Physician	H4293	TX

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	139247406	OTHER	TX	CSHCN
3	86872J	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1386634657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARSHALL DRISKELL MD

Provider Business Mailing Address
First Line	:	935 CLARK CV
Second Line	:
City	:	BUDA
State	:	TX
Zip	:	78610-3264
Country	:	US
Telephone Number	:	512-295-5401
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 WONDER WORLD DR
Second Line	:	BUILDING 4 SUITE 200
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-7598
Country	:	US
Telephone Number	:	512-392-1718
Fax Number	:

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	03/04/2009

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