Healthcare Provider Details

I. General information

NPI: 1659765907
Provider Name (Legal Business Name): JACK M JUPRASERT MD MS FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11851 JOLLYVILLE RD STE 104
AUSTIN TX
78759-2350
US

IV. Provider business mailing address

11851 JOLLYVILLE RD STE 104
AUSTIN TX
78759-2350
US

V. Phone/Fax

Practice location:
  • Phone: 512-257-2425
  • Fax: 512-257-2426
Mailing address:
  • Phone: 512-257-2425
  • Fax: 512-257-2426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberU2523
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: