Provider Demographics
NPI:1871844191
Name:JACKSON, JASON MATTHEW (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MATTHEW
Last Name:JACKSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7622 LOUIS PASTEUR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4019
Mailing Address - Country:US
Mailing Address - Phone:210-610-3859
Mailing Address - Fax:210-641-2277
Practice Address - Street 1:7622 LOUIS PASTEUR DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4019
Practice Address - Country:US
Practice Address - Phone:210-610-3859
Practice Address - Fax:210-641-2277
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
TXPA070989363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical