MEDICARE: JOHN VIJAY JAYACHANDRAN M.D.

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	207RC0000X	Cardiovascular Disease Physician	L6078	TX
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	L6078	TX

General Provider Information

NPI Number	:	1730164526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN VIJAY JAYACHANDRAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6278
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-0278
Country	:	US
Telephone Number	:	817-568-5467
Fax Number	:	817-568-5474

Provider Business Practice Location Address
First Line	:	900 JEROME ST STE 200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3940
Country	:	US
Telephone Number	:	682-268-6705
Fax Number	:	682-268-6706

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	01/27/2025

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