Provider Demographics
NPI:1104036029
Name:RYTLEWSKI, JASON ALAN (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALAN
Last Name:RYTLEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1605 E BROADWAY STE 300
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8023
Mailing Address - Country:US
Mailing Address - Phone:573-256-7700
Mailing Address - Fax:573-256-3003
Practice Address - Street 1:1605 EAST BROADWAY
Practice Address - Street 2:#300
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-256-7700
Practice Address - Fax:573-256-3003
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022032423207RC0000X, 207RC0001X
VA0101261684207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0022677OtherINSTITUTIONAL PERMIT