Provider Demographics
NPI:1396853008
Name:JERABEK, JASON B (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:B
Last Name:JERABEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:506 W LINCOLN AVE
Mailing Address - Street 2:SUITE 200 A
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2453
Mailing Address - Country:US
Mailing Address - Phone:217-281-0024
Mailing Address - Fax:217-345-7146
Practice Address - Street 1:506 W LINCOLN AVE
Practice Address - Street 2:SUITE 200 A
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2453
Practice Address - Country:US
Practice Address - Phone:217-281-0024
Practice Address - Fax:217-345-7146
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-099396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH20642Medicare UPIN
ILL85682Medicare PIN