Provider Demographics
NPI:1528223559
Name:ALISANGCO, JASON BRAVO (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRAVO
Last Name:ALISANGCO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-237-2753
Mailing Address - Fax:210-539-2081
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-237-2753
Practice Address - Fax:210-539-2081
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2022-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA63624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVAD 000Medicare UPIN