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NPI Code Detail

MEDICARE: JASON FOX WANDER DO

MEDICARE: JASON FOX WANDER 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
1207Q00000XFamily Medicine PhysicianN6762TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28BN846OTHERTXBCBSTX

General Provider Information

NPI Number : 1538367313
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON FOX WANDER DO
Provider Business Mailing Address
First Line : 601 S MAIN ST STE 200
Second Line :
City : KELLER
State : TX
Zip : 76248-7028
Country : US
Telephone Number : 817-753-6888
Fax Number : 817-753-6885
Provider Business Practice Location Address
First Line : 601 S MAIN ST STE 200
Second Line :
City : KELLER
State : TX
Zip : 76248-7028
Country : US
Telephone Number : 817-753-6888
Fax Number : 817-753-6885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2007
Last Update Date : 03/21/2023

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Directions to “ JASON FOX WANDER DO” Practice Location

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