Healthcare Provider Details

I. General information

NPI: 1447575840
Provider Name (Legal Business Name): JASON POND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 HARRY HINES BLVD GRADUATE MEDICAL EDUCATION
DALLAS TX
75235-7708
US

IV. Provider business mailing address

815 PENNSYLVANIA AVE
FORT WORTH TX
76104-2224
US

V. Phone/Fax

Practice location:
  • Phone: 214-590-8058
  • Fax:
Mailing address:
  • Phone: 817-321-0300
  • Fax: 817-321-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberP3414
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: