Individual
DR. JEFFREY A FEARON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.,F.A.C.S.
Contact information
Practice address
7777 FOREST LN STE C700, DALLAS, TX 75230-2518
(972) 566-6464
(972) 566-6279
Mailing address
7777 FOREST LN STE C700, DALLAS, TX 75230-2518
(972) 566-6464
(972) 566-6279
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
H8638
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E1668
—
MN
01
—
00X682
MEDICARE GROUP PTAN
TX
01
—
0722264
IOWA MEDICAID
IA
05
—
093725201
—
TX
05
—
10010045
—
TX
05
—
118956501
—
TX
05
—
118956502
—
TX
05
—
1921297
—
LA
05
—
208847509
—
MO
05
—
3858
—
TX
01
—
5542707
AETNA
TX
01
—
86J892
BC/BS PROVIDER ID NUMBER
TX
01
—
8F5212
MEDICARE INDIVIDUAL PTAN
TX
05
—
91863803
—
CO
Enumeration date
05/22/2006
Last updated
02/16/2017
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