Provider Demographics
NPI:1528013125
Name:DEMATTIA, JASON KELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:KELLY
Last Name:DEMATTIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:506 GRAHAM DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3346
Mailing Address - Country:US
Mailing Address - Phone:281-255-3838
Mailing Address - Fax:281-255-3788
Practice Address - Street 1:506 GRAHAM DR
Practice Address - Street 2:SUITE 200
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3346
Practice Address - Country:US
Practice Address - Phone:281-255-3838
Practice Address - Fax:281-255-3788
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-10-02
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Provider Licenses
StateLicense IDTaxonomies
TXM2306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI49820Medicare UPIN
TX8G4045Medicare ID - Type Unspecified