Provider Demographics
NPI:1205275740
Name:SIEGEL, JASON ISAAC (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ISAAC
Last Name:SIEGEL
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 1:2300 HIGHLAND VILLAGE RD STE 600
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-8102
Mailing Address - Country:US
Mailing Address - Phone:972-317-0331
Mailing Address - Fax:972-317-3811
Practice Address - Street 1:2300 HIGHLAND VILLAGE RD STE 600
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-8102
Practice Address - Country:US
Practice Address - Phone:972-317-0331
Practice Address - Fax:972-317-3811
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine