Provider Demographics
NPI:1699809921
Name:FAJARDO, JOSE D (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:D
Last Name:FAJARDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 W HIGHWAY 287 BUSINESS
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-4706
Mailing Address - Country:US
Mailing Address - Phone:972-938-1368
Mailing Address - Fax:972-938-1354
Practice Address - Street 1:1620 W HIGHWAY 287 BUSINESS
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-4706
Practice Address - Country:US
Practice Address - Phone:972-938-1368
Practice Address - Fax:972-938-1354
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0863213E00000X, 213EP0504X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018835101Medicaid
TX00TN99Medicare PIN
TX018835101Medicaid
TX0165800002Medicare NSC