Provider Demographics
NPI:1659765907
Name:JUPRASERT, JACKLY M (MD MS)
Entity Type:Individual
Prefix:DR
First Name:JACKLY
Middle Name:M
Last Name:JUPRASERT
Suffix:
Gender:M
Credentials:MD MS
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Mailing Address - Street 1:11851 JOLLYVILLE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2350
Mailing Address - Country:US
Mailing Address - Phone:512-925-0341
Mailing Address - Fax:415-353-2505
Practice Address - Street 1:11851 JOLLYVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2350
Practice Address - Country:US
Practice Address - Phone:512-925-0341
Practice Address - Fax:415-353-2505
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2023-11-17
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Provider Licenses
StateLicense IDTaxonomies
TXU2523208600000X
CAA174919208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery