Provider Demographics
NPI:1619160686
Name:TERRELL, JASON BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRADLEY
Last Name:TERRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18104 PAINTED HORSE CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-4063
Mailing Address - Country:US
Mailing Address - Phone:512-810-5323
Mailing Address - Fax:
Practice Address - Street 1:18104 PAINTED HORSE CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-4063
Practice Address - Country:US
Practice Address - Phone:512-810-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6065208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice