Provider Demographics
NPI:1326093923
Name:KING, JASON JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:JAMES
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:168 N CASEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:48755-9704
Mailing Address - Country:US
Mailing Address - Phone:989-453-5210
Mailing Address - Fax:
Practice Address - Street 1:4970 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MI
Practice Address - Zip Code:48731
Practice Address - Country:US
Practice Address - Phone:989-375-2214
Practice Address - Fax:989-375-2175
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4831635Medicaid
MI231310Medicare Oscar/Certification
MII48975Medicare UPIN