Provider Demographics
NPI:1396836862
Name:MYERS, JASON P (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:MYERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 WESTPARK WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-7901
Mailing Address - Country:US
Mailing Address - Phone:616-772-7314
Mailing Address - Fax:
Practice Address - Street 1:8300 WESTPARK WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-7901
Practice Address - Country:US
Practice Address - Phone:616-772-7314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM012685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4438616Medicaid
MIG38287Medicare UPIN
MI4438616Medicaid