Basic Information
| Provider Information | |||||||||
| NPI: | 1396135083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | SAN ANTONIO MILITARY MEDICAL CENTER, 959 MDOS/SGO5P | ||||||||
| Address2: | PULMONARY/CRITICAL CARE, 3551 ROGER BROOKE DR | ||||||||
| City: | JBSA-FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109162153 | ||||||||
| FaxNumber: | 2109160709 | ||||||||
| Practice Location | |||||||||
| Address1: | SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZDM-P | ||||||||
| Address2: | PULMONARY/CRITICAL CARE, 3551 ROGER BROOKE DR | ||||||||
| City: | JBSA-FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109162153 | ||||||||
| FaxNumber: | 2109160709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2015 | ||||||||
| LastUpdateDate: | 04/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35.135308 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208D00000X | 29759 | NE | N | Allopathic & Osteopathic Physicians | General Practice | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | OH | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 29759 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0330051 | 05 | OH | MEDICAID |