Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO289896 | FL |
NPI | 1407845530 |
---|---|
Provider Name | Dr. Scott Richard Jason |
First Address | Jacksonville, FL 32216-8931 |
Second Address | Jacksonville, FL 32216-8931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 25/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
65727 | BLUE CROSS BLUE SHIELD ID (01) | FL |
U85765 | (02) | FL |