Healthcare Provider Details

I. General information

NPI: 1710917687
Provider Name (Legal Business Name): RENE GILBERT JASO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 S LOOP 1604 W
VON ORMY TX
78073-4401
US

IV. Provider business mailing address

5290 S LOOP 1604 W
VON ORMY TX
78073-4401
US

V. Phone/Fax

Practice location:
  • Phone: 210-825-6770
  • Fax:
Mailing address:
  • Phone: 210-825-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberF2296
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberF2296
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberF2296
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: