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General NPI Number Information
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NPI Number | 1730164526
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Entity Type | Individual
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Provider Name | JOHN VIJAY JAYACHANDRAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 900 JEROME ST STE 200
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City | FORT WORTH
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State | TX
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Zip | 76104-3940
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Country | US
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Telephone | 682-268-6705
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Fax | 682-268-6706
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Provider Business Mailing Address
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Address Line | PO BOX 6278
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City | FORT WORTH
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State | TX
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Zip | 76115-0278
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Country | US
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Telephone | 817-568-5467
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Fax | 817-568-5474
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | L6078
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | L6078
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License Number State | TX
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