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NPI Code Detail

MEDICARE: TYLER CAMERON JEFFERSON PA-C

MEDICARE: TYLER CAMERON JEFFERSON 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
1363AM0700XMedical Physician AssistantPA06754TX
2363A00000XPhysician AssistantPA06754TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00954312OTHERTXRAILROAD MEDICARE
5TXB120919OTHERTXMEDICARE PART B - EFFECT 02/01/2011

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1825N93OTHERTXBCBS TEXAS
2835N03OTHERTXBCBS TX 02/01/2011
41740245968OTHERNPI

General Provider Information

NPI Number : 1740245968
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER CAMERON JEFFERSON PA-C
Provider Business Mailing Address
First Line : 2535 W OAK ST
Second Line :
City : DENTON
State : TX
Zip : 76201-2331
Country : US
Telephone Number : 940-382-1577
Fax Number : 940-387-5471
Provider Business Practice Location Address
First Line : 2535 W OAK ST
Second Line :
City : DENTON
State : TX
Zip : 76201-2331
Country : US
Telephone Number : 940-382-1577
Fax Number : 940-387-5471
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 05/23/2013

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1558708750 — DR. LESTER TENGHU ABEY DPT
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Directions to “ TYLER CAMERON JEFFERSON PA-C” Practice Location

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