Provider Demographics
NPI:1750358149
Name:SUITS, JASON P (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:SUITS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3488 DEPT 05 040
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0001
Mailing Address - Country:US
Mailing Address - Phone:936-568-8425
Mailing Address - Fax:936-568-8570
Practice Address - Street 1:1002 N MOUND ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4437
Practice Address - Country:US
Practice Address - Phone:936-569-2590
Practice Address - Fax:936-569-2592
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL8208208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165237202Medicaid
TXI02668Medicare UPIN
TXTXB147317Medicare PIN