Provider Demographics
NPI:1609867621
Name:YOUNG, JAYSON B (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAYSON
Middle Name:B
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:MC 7977
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-257-1400
Mailing Address - Fax:210-257-1428
Practice Address - Street 1:8300 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3931
Practice Address - Country:US
Practice Address - Phone:210-450-1500
Practice Address - Fax:210-450-6033
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA 02918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199807201Medicaid
TX199807201Medicaid