Healthcare Provider Details

I. General information

NPI: 1689882060
Provider Name (Legal Business Name): JOSE FAJARDO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 FERRIS AVE SUITE 214
WAXAHACHIE TX
75165-2599
US

IV. Provider business mailing address

2439 FM 55
WAXAHACHIE TX
75165-8936
US

V. Phone/Fax

Practice location:
  • Phone: 972-938-1368
  • Fax: 972-938-1354
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE FAJARDO
Title or Position: DOCTOR
Credential:
Phone: 372-398-1368