Provider Demographics
NPI:1134129620
Name:GUIN, JASON W (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:W
Last Name:GUIN
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 1:9800 SHELBYVILLE RD
Mailing Address - Street 2:SUITE #220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:855-656-7325
Practice Address - Street 1:3003 CHARLESTOWN CROSSING WAY
Practice Address - Street 2:SUITE D
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150
Practice Address - Country:US
Practice Address - Phone:812-945-5653
Practice Address - Fax:502-429-6157
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057648A207K00000X
KY37904207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200444210Medicaid
KY50001588OtherPASSPORT
KY64069198Medicaid
IN181540JMedicare PIN
KY0682413Medicare PIN
KY64069198Medicaid
H88530Medicare UPIN