Provider Demographics
NPI:1881618676
Name:BENNETT, JASON M (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 791110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78279-1110
Mailing Address - Country:US
Mailing Address - Phone:210-757-4677
Mailing Address - Fax:210-614-1055
Practice Address - Street 1:12838 VISTA DEL NORTE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-8112
Practice Address - Country:US
Practice Address - Phone:361-649-8434
Practice Address - Fax:210-614-1055
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK1359207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089904901Medicaid
TX0015ASMedicare PIN