Provider Demographics
NPI:1336218437
Name:CONN, JASON (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:CONN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 PRESTON PARK BLVD STE 2500
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3674
Mailing Address - Country:US
Mailing Address - Phone:972-733-7242
Mailing Address - Fax:972-733-7257
Practice Address - Street 1:6839 COMMUNICATIONS PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5991
Practice Address - Country:US
Practice Address - Phone:972-258-7426
Practice Address - Fax:469-549-7818
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195307702Medicaid
TX510039YZNAMedicare PIN