Provider Demographics
NPI:1861509473
Name:GUKHOOL, JASON (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GUKHOOL
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:PO BOX 301157
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1157
Mailing Address - Country:US
Mailing Address - Phone:877-639-7611
Mailing Address - Fax:
Practice Address - Street 1:2530 GULF FWY S
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6743
Practice Address - Country:US
Practice Address - Phone:281-337-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4126207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176124903Medicaid
TX8S9234OtherBCBSTX PROV NO
TX176124902Medicaid
TX1861509473OtherTRICARE SOUTH
TX8S9234OtherBCBSTX PROV NO
TXP00368303Medicare PIN
TXH31993Medicare UPIN
TX176124902Medicaid
TX176124903Medicaid