Provider Demographics
NPI:1487884664
Name:CARROLL, JASON EDWIN
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:EDWIN
Last Name:CARROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 W BEN WHITE BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7524
Mailing Address - Country:US
Mailing Address - Phone:512-326-5440
Mailing Address - Fax:512-326-8660
Practice Address - Street 1:2315 W BEN WHITE BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7524
Practice Address - Country:US
Practice Address - Phone:512-326-5440
Practice Address - Fax:512-326-8660
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9311208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362953YSN5Medicare PIN