Provider Demographics
NPI:1932377686
Name:MONTAGUE, JASON PAUL (PA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:PAUL
Last Name:MONTAGUE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1401 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-5521
Mailing Address - Country:US
Mailing Address - Phone:903-813-0790
Mailing Address - Fax:903-891-2025
Practice Address - Street 1:1401 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5521
Practice Address - Country:US
Practice Address - Phone:903-813-0790
Practice Address - Fax:903-891-2025
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01357363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS25951Medicare UPIN