MEDICARE: ASHA S JAYACHANDRAN 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	L6077	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1750369203	OTHER		GRP NPI NUMBER

General Provider Information

NPI Number	:	1467554246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHA S JAYACHANDRAN MD

Provider Business Mailing Address
First Line	:	801 7TH AVE
Second Line	:	REVENUE MANAGEMENT
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2733
Country	:	US
Telephone Number	:	682-885-4157
Fax Number	:	682-885-1903

Provider Business Practice Location Address
First Line	:	6421 MCCART AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4702
Country	:	US
Telephone Number	:	817-263-7500
Fax Number	:

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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