Provider Demographics
NPI:1487654406
Name:CARTER, JASON B (PA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:B
Last Name:CARTER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:70 W GORE ST
Mailing Address - Street 2:STE 202
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1124
Mailing Address - Country:US
Mailing Address - Phone:407-244-8559
Mailing Address - Fax:407-244-8560
Practice Address - Street 1:70 W GORE ST
Practice Address - Street 2:STE 202
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1124
Practice Address - Country:US
Practice Address - Phone:407-244-8559
Practice Address - Fax:407-244-8560
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 9102211363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0151WMedicare PIN
FLU0151VMedicare PIN
P80796Medicare UPIN