MEDICARE: JEFFREY C. KOMENDA, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	H6350	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	10018514	OTHER	TX	AMERIGROUP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003800434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY C. KOMENDA, M.D., P.A.

Provider Business Mailing Address
First Line	:	5944 W PARKER RD
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-6422
Country	:	US
Telephone Number	:	972-608-1868
Fax Number	:	972-943-8644

Provider Business Practice Location Address
First Line	:	5944 W PARKER RD
Second Line	:	SUITE 100
City	:	PLANO
State	:	TX
Zip	:	75093-6421
Country	:	US
Telephone Number	:	972-608-1868
Fax Number	:	972-943-8644

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. JEFFREY CRAIG KOMENDA
Credential	:	M.D.
Telephone Number	:	972-608-1868

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	02/28/2012

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