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Individual

JASON R DISNEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
713 E ANDERSON ST, WEATHERFORD, TX 76086-5705
(817) 596-8751
Mailing address
PO BOX 8549, FORT WORTH, TX 76124-0549
(817) 451-4208
(817) 563-3699

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L0132
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0040GU
BCBS
TX
05
132119207
TX
Enumeration date
05/28/2006
Last updated
02/05/2008
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