Provider Demographics
NPI:1528300555
Name:ROSS, JASON ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ROBERT
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RAINBOW DR # 5250
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399-9301
Mailing Address - Country:US
Mailing Address - Phone:936-433-8303
Mailing Address - Fax:
Practice Address - Street 1:101 RAINBOW DR # 5250
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77399-9301
Practice Address - Country:US
Practice Address - Phone:936-433-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-16
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2022-01322085R0202X, 2085R0204X
TXS03732085R0204X, 2085R0202X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77953029Medicaid