Provider Demographics
NPI:1639139256
Name:HILES, JASON M (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:HILES
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 1:20501 US HIGHWAY 62/180
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-8132
Mailing Address - Country:US
Mailing Address - Phone:915-235-5520
Mailing Address - Fax:
Practice Address - Street 1:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Practice Address - Street 2:18511 HIGHLANDER MEDICS STREET
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-742-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8572208600000X
NMMD2015-0807208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33910OtherSTATE LISCENSE