Provider Demographics
NPI:1245317742
Name:SCHWADE, JACK LESTER (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:LESTER
Last Name:SCHWADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE C339
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2571
Mailing Address - Country:US
Mailing Address - Phone:972-566-8855
Mailing Address - Fax:972-566-7509
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C339
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-8855
Practice Address - Fax:972-566-7509
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3394207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099892405Medicaid
TX099892404Medicaid
TX099892401Medicaid
TXTXB113346Medicare PIN
B88168Medicare UPIN
TXTXB113344Medicare PIN
TX099892404Medicaid
TX099892401Medicaid