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General NPI Number Information
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NPI Number | 1396060711
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Entity Type | Organization
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Legal Business Name | JEPSON MEDICAL AFFILIATES PA
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 11420 FM 2244 SUITE A-100
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City | AUSTIN
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State | TX
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Zip | 78738-5526
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Country | US
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Telephone | 512-263-9961
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Fax | 512-263-9963
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Provider Business Mailing Address
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Address Line | 11420 FM 2244 SUITE A-100
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City | AUSTIN
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State | TX
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Zip | 78738-5526
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Country | US
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Telephone | 512-263-9961
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Fax | 512-263-9963
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRYAN JEPSON
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Credential | M.D.
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Telephone | 512-263-9961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number |
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License Number State |
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