Provider Demographics
NPI:1487635140
Name:CLINE, JASON WAYNE (PAC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:WAYNE
Last Name:CLINE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:WAYNE
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:16020 PARK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3573
Mailing Address - Country:US
Mailing Address - Phone:512-244-0707
Mailing Address - Fax:512-244-1013
Practice Address - Street 1:16020 PARK VALLEY DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3573
Practice Address - Country:US
Practice Address - Phone:512-244-0707
Practice Address - Fax:512-244-1013
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04337207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX807677Medicare ID - Type Unspecified
284711YH3UMedicare PIN
TX807677Medicare ID - Type Unspecified
284711YH3UMedicare PIN