Provider Demographics
NPI:1083009245
Name:STATLER, JASON CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CLARK
Last Name:STATLER
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:PO BOX 8040
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-8040
Mailing Address - Country:US
Mailing Address - Phone:304-598-4646
Mailing Address - Fax:304-598-4649
Practice Address - Street 1:14 COMFORT DR
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26547
Practice Address - Country:US
Practice Address - Phone:304-864-0006
Practice Address - Fax:304-293-6963
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27795207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine