Provider Demographics
NPI:1972707578
Name:BERILGEN, JASON ERTAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ERTAN
Last Name:BERILGEN
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 1:9323 PINECROFT DR
Mailing Address - Street 2:SUITE110
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3223
Mailing Address - Country:US
Mailing Address - Phone:281-943-2440
Mailing Address - Fax:
Practice Address - Street 1:9323 PINECROFT DR
Practice Address - Street 2:SUITE110
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3223
Practice Address - Country:US
Practice Address - Phone:281-943-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM60462085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094010801OtherGROUP MEDICAID NUMBER
TX206113703Medicaid
TX0019BYOtherGROUP MEDICARE NUMBER
TX00J21AOtherGROUP MEDICARE NUMBER
TX206113701Medicaid
TX263415YKYCMedicare PIN
TX206113703Medicaid