Provider Demographics
NPI:1720237365
Name:GEORGE, JASON P (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:GEORGE
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 1:2704 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6378
Mailing Address - Country:US
Mailing Address - Phone:214-660-2500
Mailing Address - Fax:
Practice Address - Street 1:2704 N GALLOWAY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6378
Practice Address - Country:US
Practice Address - Phone:214-660-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2008757-01Medicaid
8BU165OtherBLUE CROSS BLUE SHIELD OF TEXAS
P00698645Medicare PIN
TX2008757-01Medicaid