MEDICARE: JOHN J WARE JR.

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	103TE1100X	Exercise & Sports Psychologist

General Provider Information

NPI Number	:	1427636422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J WARE JR.

Provider Business Mailing Address
First Line	:	8910 N LOOP 1604 W APT 1721
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2774
Country	:	US
Telephone Number	:	313-205-6134
Fax Number	:

Provider Business Practice Location Address
First Line	:	8910 N LOOP 1604 W APT 1721
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2774
Country	:	US
Telephone Number	:	313-205-6134
Fax Number	:

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

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	03/31/2021

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