Provider Demographics
NPI:1649276965
Name:KOURI, JASON ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALBERT
Last Name:KOURI
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 1:903 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-3421
Mailing Address - Country:US
Mailing Address - Phone:817-877-5353
Mailing Address - Fax:817-877-5357
Practice Address - Street 1:903 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3421
Practice Address - Country:US
Practice Address - Phone:817-877-5353
Practice Address - Fax:817-877-5357
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3183207QA0505X
CAA63589207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A635890Medicaid
TX393277ZMNIMedicare PIN
TX266696ZTNXMedicare PIN
CA00A635890Medicaid