Provider Demographics
NPI:1942087804
Name:JASON E BERILGEN MD PLLC
Entity type:Organization
Organization Name:JASON E BERILGEN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERLIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-898-2324
Mailing Address - Street 1:515 W GREENS RD STE 710
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-4525
Mailing Address - Country:US
Mailing Address - Phone:713-859-6820
Mailing Address - Fax:
Practice Address - Street 1:603 S CONROE MEDICAL DR STE 110
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-5395
Practice Address - Country:US
Practice Address - Phone:713-898-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty