MEDICARE: DR. JACK M JUPRASERT MD MS FACS

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	208600000X	Surgery Physician	U2523	TX

General Provider Information

NPI Number	:	1659765907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK M JUPRASERT MD MS FACS

Provider Business Mailing Address
First Line	:	11851 JOLLYVILLE RD STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-2350
Country	:	US
Telephone Number	:	512-257-2425
Fax Number	:	512-257-2426

Provider Business Practice Location Address
First Line	:	11851 JOLLYVILLE RD STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-2350
Country	:	US
Telephone Number	:	512-257-2425
Fax Number	:	512-257-2426

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

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	04/06/2026

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