# INDIEMD NETWORK LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** IndieMD Network
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275256968
- **Authorized official:** JASON RYAN FRAZIER (MANAGING MEMBER)
- **Authorized official phone:** (469) 682-5827

## Contact information

- **Practice address:** 309 WATER ST STE 107, BOERNE, TX 78006-2866
- **Practice address phone:** (469) 682-5827
- **Mailing address:** 250 STATE HIGHWAY 46 W, BOERNE, TX 78006-8118

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WW0000X | Wound Care Registered Nurse | — | NULL | — |
| 163WW0000X | Wound Care Registered Nurse | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/19/2022
- **Last updated:** 04/06/2023