| Doctor Name: | DR. JASON RODNEY SUSONG |
| NPI Number: | 1235302787 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 46240 |
| Business Practice Address: | 2200 Bergquist Dr Ste 1 Jbsa Lackland, TX - 782369907 |
| Business Phone Number: | 2102925350 |
| Business Fax Number: | 2102923781 |
| Mailing Address: | 2200 Bergquist Dr, Ste 1 JBSA LACKLAND |
| State: | TX |
| Postal Code: | 782369907 |
| Phone Number: | 2102925350 |
| Fax Number: | 2102923781 |
| NPI Enumeration Date: | 04/04/2008 |
| NPI Last Update Date: | 10/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 46240 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |