Healthcare Provider Details

I. General information

NPI: 1831577253
Provider Name (Legal Business Name): JASSON THOMAS ABRAHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8591 S BROADWAY AVE
TYLER TX
75703-5470
US

IV. Provider business mailing address

6201 GREENLEIGH AVE # MSAG407Q
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 903-606-8840
  • Fax: 903-606-1121
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberBP10053999
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberD91840
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberW7254
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: