Individual
KENNETH M JASTROW III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
102 N MAGDALEN ST, SAN ANGELO, TX 76903-5400
(325) 658-1511
(325) 481-2165
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511
(325) 481-2165
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
P4968
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8DN791
BCBS
TX
01
—
TXB154908
MEDICARE PTAN
TX
Enumeration date
03/27/2012
Last updated
04/23/2018
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