Individual
JASON S. LEDBETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1622 8TH AVENUE, SUITE 110, FORT WORTH, TX 76104-4155
(817) 921-3055
(817) 921-3708
Mailing address
PO BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 921-3708
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L2981
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110246439
RAILROAD MEDICARE
—
05
—
150094402
—
TX
Enumeration date
07/17/2006
Last updated
02/18/2010
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