Provider Demographics
NPI:1891123725
Name:GILES, JASON M (CSFA, LSA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:GILES
Suffix:
Gender:M
Credentials:CSFA, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 HIGHWAY 332 W STE J
Mailing Address - Street 2:SUITE 5 BOX 222
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4022
Mailing Address - Country:US
Mailing Address - Phone:432-230-5412
Mailing Address - Fax:
Practice Address - Street 1:117 HIGHWAY 332 W STE J
Practice Address - Street 2:SUITE 5 BOX 222
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4022
Practice Address - Country:US
Practice Address - Phone:432-230-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZS0410X
TXSA00582363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist