Provider Demographics
NPI:1225346778
Name:MCKOWN, JASON BERNARD (PA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:BERNARD
Last Name:MCKOWN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 MARKETPLACE PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-1841
Mailing Address - Country:US
Mailing Address - Phone:970-879-6663
Mailing Address - Fax:
Practice Address - Street 1:705 MARKETPLACE PLZ STE 200
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-1841
Practice Address - Country:US
Practice Address - Phone:970-879-6663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2011363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5550830001OtherMEDICARE NSC SCW
AZ201778316OtherTIN
AZ5550830004OtherMEDICARE NSC PV
AZ5550830008OtherMEDICARE NSC SWV
AZ5550830009OtherMEDICARE NSC AZ NORTH
AZ5550830006OtherMEDICARE NSC ANTHEM
AZ5550830003OtherMEDICARE NSC PEORIA
AZ5550830010OtherMEDICARE NSC GILBERT
AZ5550830007OtherMEDICARE NSC DV