Individual
JASON ROBERT CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7431 NW LOOP 410 STE 109, SAN ANTONIO, TX 78245-3597
(210) 477-7190
(210) 477-7195
Mailing address
2961 MOSSROCK, SAN ANTONIO, TX 78230-5119
(210) 731-4800
(210) 731-4810
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA08628
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3560419-01
WELLMED MEDICAID
TX
01
—
484297YPLS
WELLMED MEDICARE
TX
Enumeration date
03/05/2009
Last updated
04/20/2020
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