Provider Demographics
NPI:1487952834
Name:MCCANDLESS, JASON D (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:MCCANDLESS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2625
Mailing Address - Fax:469-282-2655
Practice Address - Street 1:910 JAMES BOWIE DR
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-2335
Practice Address - Country:US
Practice Address - Phone:903-614-5950
Practice Address - Fax:903-614-5955
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARPA-430363AM0700X
TXPA07396363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284586901Medicaid
TXTXB134280Medicare PIN