Provider Demographics
NPI:1154316545
Name:REUTTER, JASON C (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:REUTTER
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 1:1899 TATE BLVD SE
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4200
Mailing Address - Country:US
Mailing Address - Phone:828-322-3821
Mailing Address - Fax:828-322-6697
Practice Address - Street 1:1899 TATE BLVD SE
Practice Address - Street 2:SUITE 1105
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4200
Practice Address - Country:US
Practice Address - Phone:828-322-3821
Practice Address - Fax:828-322-6697
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200788174400000X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00254161OtherRAILROAD MEDICARE
2037329Medicare PIN
I26198Medicare UPIN