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Individual

JASON BUCKALOO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
700 OLYMPIC PLAZA CIR STE 600, TYLER, TX 75701-1954
(903) 596-3844
Mailing address
700 OLYMPIC PLAZA CIR STE 600, TYLER, TX 75701-1954
(903) 596-3844

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA19895
TX
363A00000X
Physician Assistant
Primary
PAT9117647
FL
363AM0700X
Medical Physician Assistant
PA9117647
FL
363AS0400X
Surgical Physician Assistant
PA19895
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
124305100
FL
01
PA19895
PA LICENSE
TX
01
PAT9117647
STATE MEDICAL LICENSE
FL
Enumeration date
02/24/2021
Last updated
06/16/2026
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