# JASPER FAMILY MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215194303
- **Authorized official:** ELIZABETH ANN BENTON (SOLE OWNER)
- **Authorized official phone:** (281) 220-7549

## Contact information

- **Practice address:** 150 W GIBSON ST, JASPER, TX 75951-4936
- **Practice address phone:** (409) 384-1700
- **Practice address fax:** (409) 384-1701
- **Mailing address:** 150 W GIBSON ST, JASPER, TX 75951-4936
- **Mailing address phone:** (409) 384-1700
- **Mailing address fax:** (409) 384-1701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | 1163 | TX | — |
| 207Q00000X | Family Medicine Physician | K4930 | TX | — |
| 363A00000X | Physician Assistant | PA03271 | TX | — |
| 363L00000X | Nurse Practitioner | 676518 | TX | Yes |

## Other

- **Enumeration date:** 05/18/2008
- **Last updated:** 11/14/2008