Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD036265 | DC |
N | 208600000X | Surgeon | MD036265 | DC |
N | 2086S0102X | Surgical Critical Care | MD036265 | DC |
Y | 2086S0102X | Surgical Critical Care | N8483 | TX |
N | 2086S0127X | Trauma Surgeon | MD036265 | DC |
NPI | 1063493039 |
---|---|
Provider Name | Dr. Jayson David Aydelotte |
First Address | Austin, TX 78701-1137 |
Second Address | Austin, TX 78701-1930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 11/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
281458401 | (05) | TX |
281458402 | CSHCN (01) | TX |
281458403 | (05) | TX |