MEDICARE: JONATHAN GUEVARA 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	207X00000X	Orthopaedic Surgery Physician	35.136220	OH
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207X00000X	Orthopaedic Surgery Physician	S5377	TX

General Provider Information

NPI Number	:	1356787188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN GUEVARA MD

Provider Business Mailing Address
First Line	:	5612 EDWARDS RANCH RD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76109-4145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5612 EDWARDS RANCH RD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76109-4145
Country	:	US
Telephone Number	:	817-420-9238
Fax Number	:	817-570-0182

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

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	09/08/2020

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