Provider Demographics
NPI:1265477681
Name:BLASER, JASON L (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:L
Last Name:BLASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DOCTOR CIR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5050
Mailing Address - Country:US
Mailing Address - Phone:903-757-3881
Mailing Address - Fax:903-757-5948
Practice Address - Street 1:1038 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2044
Practice Address - Country:US
Practice Address - Phone:903-593-9474
Practice Address - Fax:903-593-9477
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9734207ND0900X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1D341263701Medicaid
TX341263701Medicaid
MTI08947Medicare UPIN
TX341263701Medicaid
UTP00392754Medicare PIN
TX372133YSYBMedicare PIN