Provider Demographics
NPI:1679624555
Name:JASON M DEFEE, MD, PA
Entity type:Organization
Organization Name:JASON M DEFEE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:DEFEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-658-8020
Mailing Address - Street 1:3814 SHERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3539
Mailing Address - Country:US
Mailing Address - Phone:325-658-8020
Mailing Address - Fax:325-482-8608
Practice Address - Street 1:3814 SHERWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3539
Practice Address - Country:US
Practice Address - Phone:325-658-8020
Practice Address - Fax:325-482-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6027207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170094001Medicaid
TX00816XMedicare ID - Type Unspecified