Provider Demographics
NPI:1255386736
Name:MIRELES, JASON EDWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:EDWARD
Last Name:MIRELES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14726 HIDDEN GLEN WOODS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1466
Mailing Address - Country:US
Mailing Address - Phone:210-710-7547
Mailing Address - Fax:210-598-7278
Practice Address - Street 1:14726 HIDDEN GLEN WOODS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1466
Practice Address - Country:US
Practice Address - Phone:210-710-7547
Practice Address - Fax:210-598-7278
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1726213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV06083Medicare UPIN
TXTXB151522Medicare PIN