Provider Demographics
NPI:1295052504
Name:WANG, JASON T (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:T
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:419 COLE ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-5017
Mailing Address - Country:US
Mailing Address - Phone:281-973-0024
Mailing Address - Fax:281-973-0203
Practice Address - Street 1:11548 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2448
Practice Address - Country:US
Practice Address - Phone:281-973-0024
Practice Address - Fax:281-973-0203
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP3095207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308510205Medicaid
TX308510205Medicaid