Provider Demographics
NPI:1518012970
Name:MANAFI, JASON J (PA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:J
Last Name:MANAFI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13635 MICHEL RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6410
Mailing Address - Country:US
Mailing Address - Phone:281-351-7261
Mailing Address - Fax:281-351-2515
Practice Address - Street 1:13635 MICHEL RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6410
Practice Address - Country:US
Practice Address - Phone:281-351-7261
Practice Address - Fax:281-351-2515
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05008363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05008OtherLICENSE