Provider Demographics
NPI:1164624318
Name:BEARD, JASON BRYAN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:BRYAN
Last Name:BEARD
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Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:203 SUNSTONE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8764
Mailing Address - Country:US
Mailing Address - Phone:910-346-6678
Mailing Address - Fax:910-451-4437
Practice Address - Street 1:1ST BATTALION 8TH MARINES
Practice Address - Street 2:PSC 20102
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28540
Practice Address - Country:US
Practice Address - Phone:910-451-4437
Practice Address - Fax:910-451-4437
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2013-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA1102050363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant