Provider Demographics
NPI:1063415552
Name:BULLAJIAN, JASON DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DOUGLAS
Last Name:BULLAJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2600 W UNIVERSITY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-3209
Mailing Address - Country:US
Mailing Address - Phone:972-548-2015
Mailing Address - Fax:972-548-2014
Practice Address - Street 1:2600 W UNIVERSITY DR STE 100
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-3209
Practice Address - Country:US
Practice Address - Phone:972-548-2015
Practice Address - Fax:972-548-2014
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9117207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167417801Medicaid
TX167417802Medicaid
TX8AM140OtherBCBS
TXP00447469Medicare PIN
TX8AM140OtherBCBS