Individual
JASON GOURLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 358-2078
(210) 358-1972
Mailing address
7703 FLOYD CURL DR, SAN ANTONIO, TX 78229-3901
(210) 358-2078
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA01671
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
189458601
—
TX
05
—
189458602
—
TX
Enumeration date
08/24/2006
Last updated
10/29/2014
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