Provider Demographics
NPI:1538509484
Name:ZELLER, JASON S (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:ZELLER
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:PO BOX 40,000
Mailing Address - Street 2:ATTN: MEDICAL STAFF OFFICE
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658
Mailing Address - Country:US
Mailing Address - Phone:970-476-2451
Mailing Address - Fax:970-470-6458
Practice Address - Street 1:MSC 11 6025 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-5062
Practice Address - Fax:505-272-6503
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2017-0420207P00000X, 390200000X
NY390200000X
CODR.0065343207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program