Basic Information
Provider Information
NPI: 1053767913
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOOTE
FirstName: JARED
MiddleName: THOMAS
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7703 FLOYD CURL DR
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782293901
CountryCode: US
TelephoneNumber: 2105674500
FaxNumber:  
Practice Location
Address1: 7703 FLOYD CURL DR
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782293901
CountryCode: US
TelephoneNumber: 2105674500
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/10/2016
LastUpdateDate: 04/02/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/02/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207LP3000XS2300TXN Allopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
207L00000XS230PTXY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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