Provider Demographics
NPI:1356310734
Name:YSASAGA, JASON EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:EDWARD
Last Name:YSASAGA
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 50720
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-0720
Mailing Address - Country:US
Mailing Address - Phone:806-467-0459
Mailing Address - Fax:806-355-1284
Practice Address - Street 1:7411 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1835
Practice Address - Country:US
Practice Address - Phone:806-351-1870
Practice Address - Fax:806-355-1284
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4182207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150770901Medicaid
TX150770903Medicaid
TX8G3580OtherBCBS
TXH21479Medicare UPIN
TX150770903Medicaid
TX8G3580OtherBCBS