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Individual
JASON KELLY BROCKWAY
Active
Individual
JASON KELLY BROCKWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K0427
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
081026902
—
TX
05
—
113244103
—
TX
05
—
113244106
—
TX
01
—
117311
SUPERIOR CHIPS
TX
01
—
5411635
AETNA
TX
01
—
752616977017
TRICARE CHAMPUS
TX
01
—
87581G
BCBS OF TEXAS
TX
Enumeration date
02/10/2006
Last updated
04/10/2024
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