Provider Demographics
NPI:1598736829
Name:WASSON, JAMES LOUIS (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LOUIS
Last Name:WASSON
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:649 S BROADWAY AVE
Mailing Address - Street 2:STE. 2
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1677
Mailing Address - Country:US
Mailing Address - Phone:903-939-2273
Mailing Address - Fax:903-581-2137
Practice Address - Street 1:649 S BROADWAY AVE STE 2
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1677
Practice Address - Country:US
Practice Address - Phone:903-939-2273
Practice Address - Fax:903-581-2137
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6274207V00000X, 207VC0200X, 207VE0102X, 207VG0400X, 207VM0101X, 207VX0000X, 207VX0201X, 2471B0102X, 2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VC0200XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyCritical Care Medicine
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone Densitometry
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160059002OtherRAILROAD MEDICARE PTAN
TX61321OtherAMERIGROUP
TX8G2280OtherBLUECROSSBLUESHIELD
TX123576405Medicaid
TXF77441Medicare UPIN
TX123576405Medicaid