Provider Demographics
NPI:1326545500
Name:TURNER, JASON TY (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:TY
Last Name:TURNER
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 1:921 OAK PARK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3400
Mailing Address - Country:US
Mailing Address - Phone:216-844-1000
Mailing Address - Fax:
Practice Address - Street 1:921 OAK PARK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3400
Practice Address - Country:US
Practice Address - Phone:805-546-0411
Practice Address - Fax:805-473-4891
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1835542086S0129X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery