Provider Demographics
NPI:1073142923
Name:DEWITT, JASON (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DEWITT
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 1:8221 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4146
Mailing Address - Country:US
Mailing Address - Phone:480-686-0767
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD # MS 3015
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-3454
Practice Address - Country:US
Practice Address - Phone:913-588-2000
Practice Address - Fax:913-588-2061
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program