Provider Demographics
NPI:1396839957
Name:OLIPHANT, JASON S (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:S
Last Name:OLIPHANT
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 1:12995 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-9528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2551 E VISTOSO COMMERCE LOOP
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-9124
Practice Address - Country:US
Practice Address - Phone:520-545-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ441532085B0100X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ600935Medicaid
AZP00921777OtherPHYSICIAN INDIVIDUAL MEDICARE RAILROAD PTAN
AZ1396839957OtherPHYSICIAN INDIVIDUAL NPI
AZP00921777OtherPHYSICIAN INDIVIDUAL MEDICARE RAILROAD PTAN
AZ1396839957Medicare UPIN