Healthcare Provider Details

I. General information

NPI: 1427082874
Provider Name (Legal Business Name): JASON OKULICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/18/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BROOKE ARMY MEDICAL CENTER 3551 ROGER BROOKE DRIVE
FORT SAM HOUSTON TX
78234
US

IV. Provider business mailing address

BROOKE ARMY MEDICAL CENTER 3551 ROGER BROOKE DRIVE
FORT SAM HOUSTON TX
78234
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-5554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101236197
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: