Provider Demographics
NPI:1568529741
Name:REXROTH, JASON A (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:REXROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 GLASS RD NE STE 2
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2549
Mailing Address - Country:US
Mailing Address - Phone:319-200-5900
Mailing Address - Fax:319-200-5919
Practice Address - Street 1:4207 GLASS RD NE STE 2
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2549
Practice Address - Country:US
Practice Address - Phone:319-200-5900
Practice Address - Fax:319-200-5919
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA35016207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0295188Medicaid
IA0295188Medicaid
IAI9843Medicare PIN