MEDICARE: DR. JAN FREDRIC FUERST 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	207N00000X	Dermatology Physician	D8226	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	826073125	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2222809	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1669487526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAN FREDRIC FUERST MD

Provider Business Mailing Address
First Line	:	909 FROSTWOOD
Second Line	:	STE 311
City	:	HOUSTON
State	:	TX
Zip	:	77024-2309
Country	:	US
Telephone Number	:	713-468-7033
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 FROSTWOOD
Second Line	:	STE 311
City	:	HOUSTON
State	:	TX
Zip	:	77024-2309
Country	:	US
Telephone Number	:	713-468-7033
Fax Number	:

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/25/2007

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