Provider Demographics
NPI:1003969684
Name:ALDRED, JASON LAMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LAMAR
Last Name:ALDRED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:610 S SHERMAN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1342
Mailing Address - Country:US
Mailing Address - Phone:509-458-7720
Mailing Address - Fax:509-777-0432
Practice Address - Street 1:610 S SHERMAN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1342
Practice Address - Country:US
Practice Address - Phone:509-458-7720
Practice Address - Fax:509-777-0432
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD267122084N0400X
WI525662084N0400X
WAMD604411192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8926851Medicare PIN