Individual
DR. JERRAN VASCOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 CITYWEST BLVD, STE. 300, HOUSTON, TX 77042-2300
(713) 620-4000
(713) 458-4229
Mailing address
PO BOX 650865, DALLAS, TX 75265-0865
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
P1501
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302425901
—
TX
01
—
8DJ828
BCBS
TX
01
—
P01232846
RR MEDICARE
TX
01
—
TXB8DJ828
BLUE CROSS BLUE SHIELDS
TX
Enumeration date
05/25/2012
Last updated
03/08/2017
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