Provider Demographics
NPI:1205040383
Name:ROSENQUIST, JASON L (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:L
Last Name:ROSENQUIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:KENDALIA
Mailing Address - State:TX
Mailing Address - Zip Code:78027-0422
Mailing Address - Country:US
Mailing Address - Phone:830-833-2793
Mailing Address - Fax:830-833-2231
Practice Address - Street 1:2191 TWIN SISTERS DR
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6640
Practice Address - Country:US
Practice Address - Phone:830-833-2793
Practice Address - Fax:830-833-2231
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL8927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine