Provider Demographics
NPI:1467947663
Name:ALEXANDER, JASON DAVID (IDC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 TROUT AVE
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340
Mailing Address - Country:US
Mailing Address - Phone:860-649-6451
Mailing Address - Fax:
Practice Address - Street 1:USS KENTUCKY
Practice Address - Street 2:SSBN
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:98312
Practice Address - Country:US
Practice Address - Phone:229-867-5309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman