Provider Demographics
NPI:1477573095
Name:BOWLING, JASON E (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:E
Last Name:BOWLING
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 2748
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78299-2748
Mailing Address - Country:US
Mailing Address - Phone:512-341-1258
Mailing Address - Fax:512-323-5287
Practice Address - Street 1:2400 ROUND ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4004
Practice Address - Country:US
Practice Address - Phone:512-341-1258
Practice Address - Fax:512-323-5287
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN/A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161299602Medicaid
TXP00210385OtherRAILROAD MEDICARE
TX8R7680OtherBLUE CROSS BLUE SHIELD
TX161299602Medicaid