Provider Demographics
NPI:1164481925
Name:BUTLER, JASMIN SANTOS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JASMIN
Middle Name:SANTOS
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JASMIN
Other - Middle Name:SANTOS
Other - Last Name:FURLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-539-9582
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-3216
Practice Address - Fax:210-916-3758
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06700363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty