Provider Demographics
NPI:1023209368
Name:PEERY, JASON ANDREW (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ANDREW
Last Name:PEERY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2022-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110002547363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1023209368OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1023209368OtherAETNA
VA0123209368OtherMEDICAID QMB
VA1023209368OtherINTOTAL
VA1023209368OtherBLACK LUNG
VA540506332108OtherTRICARE/CHAMPUS
VAP00831116OtherRAILROAD MEDICARE
VA1023209368OtherANTHEM MEDIGAP
VA1023209368OtherCCC VA PREMIER
VA1023209368OtherHUMANA MEDICARE
VA1023209368OtherOPTIMA HEALTH PLAN
VA1023209368OtherANTHEM MEDIGAP