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NPI Code Detail

MEDICARE: JONATHAN BABCOCK DO

MEDICARE: JONATHAN BABCOCK DO
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
1208D00000XGeneral Practice Physician3106NE

General Provider Information

NPI Number : 1508623018
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN BABCOCK DO
Provider Business Mailing Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : JBSA FT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 210-916-7500
Fax Number :
Provider Business Practice Location Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : JBSA FT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 210-916-5000
Fax Number : 210-916-2077
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2024
Last Update Date : 01/07/2026

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