Individual
JASON PHILLIP JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
540 MADISON OAK DR, STE 610, SAN ANTONIO, TX 78258-3924
(210) 352-5346
(210) 352-5367
Mailing address
10278 MISSION CRK, CONVERSE, TX 78109-1680
(210) 685-7857
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA00556
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12678940
CAQH
TX
01
—
85NN35
BCBSTX
TX
01
—
SA00556
LSA LICENSE
TX
Enumeration date
02/25/2007
Last updated
12/09/2022
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