MEDICARE: MR. JASON EDWARD BABCOCK N.P.

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	208600000X	Surgery Physician	616672	TX
2	2086S0127X	Trauma Surgery Physician	616672	TX
3	363LC0200X	Critical Care Medicine Nurse Practitioner	AP112045	TX

General Provider Information

NPI Number	:	1780748277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON EDWARD BABCOCK N.P.

Provider Business Mailing Address
First Line	:	2900 NORTH ST
Second Line	:	STE. 312
City	:	BEAUMONT
State	:	TX
Zip	:	77702-1512
Country	:	US
Telephone Number	:	409-899-8501
Fax Number	:	409-899-8510

Provider Business Practice Location Address
First Line	:	2900 NORTH ST
Second Line	:	STE. 312
City	:	BEAUMONT
State	:	TX
Zip	:	77702-1512
Country	:	US
Telephone Number	:	409-899-8501
Fax Number	:	409-899-8510

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	05/26/2022

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