MEDICARE: JEPSON MEDICAL AFFILIATES PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111NS0005X	Sports Physician Chiropractor
2	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician
3	207PS0010X	Sports Medicine (Emergency Medicine) Physician

General Provider Information

NPI Number	:	1396060711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEPSON MEDICAL AFFILIATES PA

Provider Business Mailing Address
First Line	:	11420 FM 2244
Second Line	:	SUITE A-100
City	:	AUSTIN
State	:	TX
Zip	:	78738-5526
Country	:	US
Telephone Number	:	512-263-9961
Fax Number	:	512-263-9963

Provider Business Practice Location Address
First Line	:	11420 FM 2244
Second Line	:	SUITE A-100
City	:	AUSTIN
State	:	TX
Zip	:	78738-5526
Country	:	US
Telephone Number	:	512-263-9961
Fax Number	:	512-263-9963

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRYAN JEPSON
Credential	:	M.D.
Telephone Number	:	512-263-9961

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	03/30/2010

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