MEDICARE: DR. JEFFREY A FEARON M.D.,F.A.C.S.

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	2086S0122X	Plastic and Reconstructive Surgery Physician	H8638	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	00X682	OTHER	TX	MEDICARE GROUP PTAN
9	8F5212	OTHER	TX	MEDICARE INDIVIDUAL PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	5542707	OTHER	TX	AETNA
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	86J892	OTHER	TX	BC/BS PROVIDER ID NUMBER

General Provider Information

NPI Number	:	1538113592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY A FEARON M.D.,F.A.C.S.

Provider Business Mailing Address
First Line	:	7777 FOREST LN STE C700
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2518
Country	:	US
Telephone Number	:	972-566-6464
Fax Number	:	972-566-6279

Provider Business Practice Location Address
First Line	:	7777 FOREST LN STE C700
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2518
Country	:	US
Telephone Number	:	972-566-6464
Fax Number	:	972-566-6279

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	02/16/2017

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Directions to “ DR. JEFFREY A FEARON M.D.,F.A.C.S.” Practice Location

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