MEDICARE: DR. JON JASON O'PRY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	L7505	TX

General Provider Information

NPI Number	:	1073576591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON JASON O'PRY M.D.

Provider Business Mailing Address
First Line	:	RAF LAKENHEATH 48 MDG/SGOT
Second Line	:	UNIT 5210 BOX 230
City	:	APO
State	:	AE
Zip	:	09461-0230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	WILFORD HALL AMBULATORY SURGICAL CENTER
Second Line	:	1100 WILFORD HALL LOOP, BLDG 4554
City	:	JBSA-LACKLAND AFB
State	:	TX
Zip	:	78236-9908
Country	:	US
Telephone Number	:	210-292-6376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	08/10/2021

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