MEDICARE: MRS. AMY J JATZLAU MD

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	208000000X	Pediatrics Physician	L8576	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

General Provider Information

NPI Number	:	1235198706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY J JATZLAU MD

Provider Business Mailing Address
First Line	:	219 B EAST RAILROAD
Second Line	:
City	:	GIDDINGS
State	:	TX
Zip	:	78942
Country	:	US
Telephone Number	:	979-542-0710
Fax Number	:	979-542-0748

Provider Business Practice Location Address
First Line	:	219 B EAST RAILROAD
Second Line	:
City	:	GIDDINGS
State	:	TX
Zip	:	78942
Country	:	US
Telephone Number	:	979-542-0710
Fax Number	:	979-542-0748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	05/15/2019

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