Provider Demographics
NPI:1053315010
Name:BADGWELL, JON MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:MICHAEL
Last Name:BADGWELL
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:PO BOX 162835
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-2835
Mailing Address - Country:US
Mailing Address - Phone:817-334-0530
Mailing Address - Fax:817-334-0235
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4054
Practice Address - Fax:682-885-7497
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8139207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMV2811Medicaid
OK100128470AMedicaid
TX107880102Medicaid
TX107880104OtherFIRSTCARE COMMERICAL
TX137345809OtherMEDICAID GROUP
TX140442853OtherCSHCN GROUP
TX00N47FOtherMEDICARE GROUP
NM201000424OtherPRESBYTERIAN COMMERCIAL
B174OtherTRIWEST
TX129844006Medicaid
TX87249ZOtherHMO BLUE
TX129844011OtherCSHCN
TX1447220850OtherNPI GROUP
NM201000424Medicaid
TX129844008Medicaid
TX129844010Medicaid
TX8F0118OtherBC/BS
TX107880104OtherFIRSTCARE COMMERICAL
TX1447220850OtherNPI GROUP
NMV2811Medicaid
TX8L2361Medicare PIN