# INDIEMD TX MANAGEMENT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740903434
- **Authorized official:** MR. JASON RYAN FRAZIER (OWNER)
- **Authorized official phone:** (877) 988-7420

## Contact information

- **Practice address:** 309 WATER ST STE 108, BOERNE, TX 78006-2866
- **Practice address phone:** (877) 988-7420
- **Mailing address:** 309 WATER ST STE 108, BOERNE, TX 78006-2866
- **Mailing address phone:** (877) 988-7420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 202D00000X | Integrative Medicine Physician | — | NULL | — |
| 202D00000X | Integrative Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 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:** 08/28/2024