Provider Demographics
NPI:1528321007
Name:CYPERT, JASON (ATP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CYPERT
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1908
Mailing Address - Country:US
Mailing Address - Phone:512-458-4589
Mailing Address - Fax:512-454-9521
Practice Address - Street 1:13213 HWY 155 S
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6561
Practice Address - Country:US
Practice Address - Phone:903-509-4446
Practice Address - Fax:903-509-4448
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXATP48558247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other