Provider Demographics
NPI:1275117657
Name:GHASEMLOIAN, JASMIN (DO)
Entity type:Individual
Prefix:DR
First Name:JASMIN
Middle Name:
Last Name:GHASEMLOIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 KINGSWOOD BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4502
Mailing Address - Country:US
Mailing Address - Phone:972-817-8195
Mailing Address - Fax:
Practice Address - Street 1:3095 KINGSWOOD BLVD STE 250
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-4502
Practice Address - Country:US
Practice Address - Phone:972-817-8195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU9929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program