Basic Information
Provider Information
NPI: 1003015967
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FELTON
FirstName: JASON
MiddleName: ANDREW
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5219 CITY BANK PKWY STE 35
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794073545
CountryCode: US
TelephoneNumber: 8067610333
FaxNumber: 8067857685
Practice Location
Address1: 3502 9TH ST STE 430
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794153368
CountryCode: US
TelephoneNumber: 8067610535
FaxNumber: 8067610534
Other Information
ProviderEnumerationDate: 07/12/2007
LastUpdateDate: 01/29/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207T00000X2003014735MON Allopathic & Osteopathic PhysiciansNeurological Surgery 
207T00000XP0208TXY Allopathic & Osteopathic PhysiciansNeurological Surgery 

No ID Information.


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