Provider Demographics
NPI:1518931351
Name:JASON, WILLIAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:JASON
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 1:12212 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-2631
Mailing Address - Country:US
Mailing Address - Phone:352-683-0007
Mailing Address - Fax:352-556-5223
Practice Address - Street 1:12212 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-2631
Practice Address - Country:US
Practice Address - Phone:352-683-0007
Practice Address - Fax:352-556-5223
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064899L207X00000X
FLME74687207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001692547Medicaid
1343003OtherBLUE SHIELD
FL92027OtherBCBS
FL000264100Medicaid
1343003OtherBLUE SHIELD
G12026Medicare ID - Type Unspecified