Provider Demographics
NPI:1417161753
Name:HEDRICK, JASON THOMAS (MD,)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:THOMAS
Last Name:HEDRICK
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 1:9985 DAYTON LEBANON PIKE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4231
Mailing Address - Country:US
Mailing Address - Phone:937-305-5012
Mailing Address - Fax:937-886-9194
Practice Address - Street 1:9985 DAYTON LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-4231
Practice Address - Country:US
Practice Address - Phone:937-305-5012
Practice Address - Fax:937-886-9194
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208600000X208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery