Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0863 | TX |
N | 222Z00000X | Podiatrist | 0863 | TX |
N | 213EP0504X | Public Medicine | 0863 | TX |
N | 213EP1101X | Primary Podiatric Medicine | 0863 | TX |
N | 111NR0200X | Radiology | 0863 | TX |
N | 213ER0200X | Radiology | 0863 | TX |
N | 2081S0010X | Sports Medicine | 0863 | TX |
N | 213ES0000X | Sports Medicine | 0863 | TX |
N | 213ES0103X | Foot & Ankle Surgery | 0863 | TX |
Y | 213ES0131X | Foot Surgery | 0863 | TX |
NPI | 1699809921 |
---|---|
Provider Name | Dr. Jose D Fajardo |
First Address | Waxahachie, TX 75165-4706 |
Second Address | Waxahachie, TX 75165-4706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018835101 | (05) | TX |
T13217 | (02) | TX |