Organization
TRADITIONS EMERGENCY MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM JERNBERG MD (PRESIDENT)
(469) 401-2386
Entity
Organization
Contact information
Practice address
1604 ROCK PRAIRIE RD, COLLEGE STATION, TX 77845-8345
(979) 764-5100
Mailing address
13737 NOEL RD, STE 1600, DALLAS, TX 75240-1331
(469) 401-2386
(214) 712-2444
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171501301
—
TX
Enumeration date
06/10/2006
Last updated
06/16/2014
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