MEDICARE: TEXAS LAPAROSCOPIC BARIATRICS

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	L8721	TX

General Provider Information

NPI Number	:	1952521601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS LAPAROSCOPIC BARIATRICS

Provider Business Mailing Address
First Line	:	515 W MAYFIELD RD STE 311
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-2085
Country	:	US
Telephone Number	:	817-419-9200
Fax Number	:	817-419-9215

Provider Business Practice Location Address
First Line	:	515 W MAYFIELD RD STE 311
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-2085
Country	:	US
Telephone Number	:	817-419-9200
Fax Number	:	817-419-9215

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	JASON HARRISON
Credential	:	M.D., F.A.C.S
Telephone Number	:	817-419-9200

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	06/12/2008

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