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General NPI Number Information
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NPI Number | 1982640116
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Entity Type | Individual
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Provider Name | JASON SQUIRES PA
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 698 WESTSIDE DR STE 110
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City | DURANT
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State | OK
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Zip | 74701-3085
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Country | US
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 5012 US HWY 75, SUITE 300 ATTN BILLING
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City | DENISON
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State | TX
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Zip | 75020-4589
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Country | US
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Telephone | 580-920-1922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA02526
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License Number State | TX
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