=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013550847
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JW FAMILY MEDICINE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2019
-----------------------------------------------------
Last Update Date | 10/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6230 FM 1463 SUITE 800
-----------------------------------------------------
City | FULSHEAR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-630-8585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21302 PLUM GATE CT
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77407-1425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-815-3226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. JOSE WILLIAM AGUIRRE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 914-815-3226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------