Provider Demographics
NPI:1740380534
Name:ACEVEDO, JASON LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LUIS
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-437-8655
Mailing Address - Fax:
Practice Address - Street 1:1665 ANTILLEY RD STE 180
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5249
Practice Address - Country:US
Practice Address - Phone:325-793-5165
Practice Address - Fax:325-793-5346
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP9782207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092148801Medicaid