Provider Demographics
NPI:1437377256
Name:WHITE, JASON F
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:F
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHEYENNE AVE
Mailing Address - Street 2:LAME DEER COMMUNITY HEALTH CENTER
Mailing Address - City:LAME DEER
Mailing Address - State:MT
Mailing Address - Zip Code:59043
Mailing Address - Country:US
Mailing Address - Phone:406-477-4448
Mailing Address - Fax:406-477-4457
Practice Address - Street 1:100 CHEYENNE AVE
Practice Address - Street 2:LAME DEER COMMUNITY HEALTH CENTER
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043
Practice Address - Country:US
Practice Address - Phone:406-477-4448
Practice Address - Fax:406-477-4457
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-26436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist