Provider Demographics
NPI:1215126156
Name:SEIDEN, JASON ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ANDREW
Last Name:SEIDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 16693
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76162-0693
Mailing Address - Country:US
Mailing Address - Phone:817-293-1200
Mailing Address - Fax:817-293-1202
Practice Address - Street 1:11803 SOUTH FWY
Practice Address - Street 2:SUITE 104
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7012
Practice Address - Country:US
Practice Address - Phone:817-293-1200
Practice Address - Fax:817-293-1202
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP3582207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308829601Medicaid
TXTXB163366Medicare PIN