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General NPI Number Information
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NPI Number | 1003251497
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Entity Type | Individual
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Provider Name | JAN PETRASEK M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 5201 HARRY HINES BLVD GRADUATE MEDICAL EDUCATION
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City | DALLAS
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State | TX
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Zip | 75235-7708
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Country | US
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Telephone | 214-590-8058
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-4775
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Fax | 601-815-0434
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 27717
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 27717
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10047494
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | Q8602
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License Number State | TX
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