Provider Demographics
NPI:1497957666
Name:MUSSER, JASON PAUL (IDC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:PAUL
Last Name:MUSSER
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 1:312 WATTS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-9009
Mailing Address - Country:US
Mailing Address - Phone:912-674-8685
Mailing Address - Fax:
Practice Address - Street 1:USS WEST VIRGINIA (SSBN 736) (BLUE)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:34093
Practice Address - Country:US
Practice Address - Phone:912-674-8685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman