Provider Demographics
NPI:1053652883
Name:LOSEE, JASON THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:THOMAS
Last Name:LOSEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:319 SERGEANT SQUARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-1240
Mailing Address - Country:US
Mailing Address - Phone:712-943-2500
Mailing Address - Fax:712-953-5696
Practice Address - Street 1:319 SERGEANT SQUARE DR
Practice Address - Street 2:
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-7729
Practice Address - Country:US
Practice Address - Phone:712-943-2500
Practice Address - Fax:712-943-5696
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA05015207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program