Provider Demographics
NPI:1043530587
Name:MORICH, JASON ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ROBERT
Last Name:MORICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 WOODWORTH DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOOD PARKDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97041-8732
Mailing Address - Country:US
Mailing Address - Phone:971-645-6767
Mailing Address - Fax:
Practice Address - Street 1:1700 E 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3317
Practice Address - Country:US
Practice Address - Phone:541-296-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD157218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine