Provider Demographics
NPI:1558572651
Name:SUGAR, JASON MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:SUGAR
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 1:2420 S UNION AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1322
Mailing Address - Country:US
Mailing Address - Phone:253-272-8148
Mailing Address - Fax:253-404-0506
Practice Address - Street 1:3209 S 23RD ST
Practice Address - Street 2:STE 340
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1602
Practice Address - Country:US
Practice Address - Phone:253-272-8148
Practice Address - Fax:253-404-0506
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60002192207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8513046Medicaid
WAMD60002192OtherWA LICENSE
WAG8874631Medicare PIN
WA8513046Medicaid
WAG8851594Medicare PIN
WAG8874567Medicare PIN
WAP00671970Medicare PIN
WAG8851595Medicare PIN
WA000188100Medicare PIN
WA001045700Medicare PIN
WAG8851597Medicare PIN
WAMD60002192OtherWA LICENSE
WA8851594Medicare PIN
WAG8880511Medicare PIN