MEDICARE: MS. JANE ELIZABETH GLADFELTER PA-C

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	363AM0700X	Medical Physician Assistant	PA08142	TX

General Provider Information

NPI Number	:	1710223649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANE ELIZABETH GLADFELTER PA-C

Provider Business Mailing Address
First Line	:	1800 S EGRET BAY BLVD
Second Line	:	APT 8107
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-1420
Country	:	US
Telephone Number	:	202-450-0026
Fax Number	:

Provider Business Practice Location Address
First Line	:	10950 RESOURCE PKWY
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77089-6158
Country	:	US
Telephone Number	:	281-484-5587
Fax Number	:

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

Provider Enumeration Date	:	12/21/2012
Last Update Date	:	12/21/2012

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