Provider Demographics
NPI:1316483191
Name:CAZARES, JASON (LAT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:CAZARES
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17450 ST. LUKE'S WAY
Mailing Address - Street 2:MEDICAL ARTS CENTER III, #350
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384
Mailing Address - Country:US
Mailing Address - Phone:936-266-3130
Mailing Address - Fax:
Practice Address - Street 1:17450 ST. LUKE'S WAY
Practice Address - Street 2:MEDICAL ARTS CENTER III, #350
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:936-266-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT55732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer