Basic Information
| Provider Information | |||||||||
| NPI: | 1336218437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONN | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1820 PRESTON PARK BLVD STE 2500 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750933674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727337242 | ||||||||
| FaxNumber: | 9727337257 | ||||||||
| Practice Location | |||||||||
| Address1: | 6839 COMMUNICATIONS PKWY | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750245991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722587426 | ||||||||
| FaxNumber: | 4695497818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 07/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L3612 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 195307702 | 05 | TX | MEDICAID |