Provider Demographics
NPI:1770119059
Name:VAN BUREN, JASON THOMAS
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:THOMAS
Last Name:VAN BUREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-3718
Mailing Address - Country:US
Mailing Address - Phone:281-670-4333
Mailing Address - Fax:
Practice Address - Street 1:1606 NORWOOD ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-3718
Practice Address - Country:US
Practice Address - Phone:281-670-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41452261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech