Healthcare Provider Details

I. General information

NPI: 1336761584
Provider Name (Legal Business Name): JFC MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6470 NAPLES DR
IRVING TX
75039-4167
US

IV. Provider business mailing address

6470 NAPLES DR
IRVING TX
75039-4167
US

V. Phone/Fax

Practice location:
  • Phone: 915-867-3989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: J FERNANDO CASTANEDA
Title or Position: CEO
Credential: PA-C
Phone: 915-867-3989