MEDICARE: JASON S. LEDBETTER 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	207R00000X	Internal Medicine Physician	L2981	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110246439	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790702314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON S. LEDBETTER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-921-3708

Provider Business Practice Location Address
First Line	:	1622 8TH AVENUE
Second Line	:	SUITE 110
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4155
Country	:	US
Telephone Number	:	817-921-3055
Fax Number	:	817-921-3708

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	02/18/2010

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Directions to “ JASON S. LEDBETTER M.D.” Practice Location

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