Provider Demographics
NPI:1568605103
Name:JASON, JANINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:
Last Name:JASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42338 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97465-9528
Mailing Address - Country:US
Mailing Address - Phone:404-483-1830
Mailing Address - Fax:
Practice Address - Street 1:42338 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:PORT ORFORD
Practice Address - State:OR
Practice Address - Zip Code:97465-9528
Practice Address - Country:US
Practice Address - Phone:404-483-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33623208000000X, 2080P0201X, 2080P0208X
ORMD27487208000000X, 2080P0201X, 2080P0208X
SCVL 145208000000X, 2080I0007X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080I0007XAllopathic & Osteopathic PhysiciansPediatricsClinical & Laboratory Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases