Provider Demographics
NPI:1528379435
Name:HORINOUCHI, JASON HIDEO (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:HIDEO
Last Name:HORINOUCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:975 E 3RD ST
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-3110
Mailing Address - Fax:423-778-3146
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-266-1490
Practice Address - Fax:423-778-2108
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI5894207Q00000X
TN49981208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine