MEDICARE: MR. JOHN WILLIAM ZERN 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	363A00000X	Physician Assistant	PA01814	TX
2	363AM0700X	Medical Physician Assistant	PA01814	TX

General Provider Information

NPI Number	:	1407274988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN WILLIAM ZERN P.A.

Provider Business Mailing Address
First Line	:	1920 E STATE HIGHWAY 114
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6510
Country	:	US
Telephone Number	:	817-489-9874
Fax Number	:	817-410-6466

Provider Business Practice Location Address
First Line	:	3651 WESLAYAN ST
Second Line	:	SUITE 106
City	:	HOUSTON
State	:	TX
Zip	:	77027-6833
Country	:	US
Telephone Number	:	713-622-5698
Fax Number	:	713-622-3551

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

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	04/02/2014

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Directions to “ MR. JOHN WILLIAM ZERN P.A.” Practice Location

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