MEDICARE: JAXON MAK & ASSOCIATES INC

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	367500000X	Certified Registered Nurse Anesthetist	669132	TX

General Provider Information

NPI Number	:	1942554431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAXON MAK & ASSOCIATES INC

Provider Business Mailing Address
First Line	:	7362 REMCON CIR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1623
Country	:	US
Telephone Number	:	915-225-2268
Fax Number	:

Provider Business Practice Location Address
First Line	:	7362 REMCON CIR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1623
Country	:	US
Telephone Number	:	915-225-2268
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WILLIAM BAPTIST
Credential	:	CRNA
Telephone Number	:	915-225-2268

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	03/18/2013

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