Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1308 | TX |
N | 222Z00000X | Podiatrist | 1308 | TX |
Y | 224P00000X | Prosthetist | 1308 | TX |
NPI | 1366700445 |
---|---|
Provider Name | Jason M Jennings |
First Address | Friendswood, TX 77546-3828 |
Second Address | Friendswood, TX 77546-3828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2012 |
Last Update Date | 21/12/2020 |