Individual
JENNIFER OTTO RASY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5325 HARRY HINES BLVD, DALLAS, TX 75284-1032
(469) 291-3372
Mailing address
PO BOX 845347, DALLAS, TX 75284-7208
(979) 324-0046
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
04774T
TX
363A00000X
Physician Assistant
Primary
PA04774
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8G4622
MEDICARE PROVIDER NUMBER
—
01
—
8N9962
BCBS NUMBER
TX
Enumeration date
08/18/2006
Last updated
10/16/2019
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