Basic Information
| Provider Information | |||||||||
| NPI: | 1821261629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | TABIAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2017 NEW BRAUNFELS | ||||||||
| Address2: | |||||||||
| City: | FORNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751268198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148413017 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3500 GASTON AVE | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752462017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148202361 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2008 | ||||||||
| LastUpdateDate: | 04/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | N8326 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 286702003 | 05 | TX | MEDICAID | P01701269 | 01 | TX | RAILROAD | OTHER |