Healthcare Provider Details

I. General information

NPI: 1497893374
Provider Name (Legal Business Name): JARED ADAM HOUGH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CROSS ST
MADISONVILLE TX
77864-2432
US

IV. Provider business mailing address

2800 S TEXAS AVE SUITE 202
BRYAN TX
77802-5361
US

V. Phone/Fax

Practice location:
  • Phone: 936-349-1571
  • Fax:
Mailing address:
  • Phone: 979-774-2060
  • Fax: 979-776-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09176
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: