Provider Demographics
NPI:1588673032
Name:FRANKLIN, JASON TYLER (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:TYLER
Last Name:FRANKLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CROSSLAKE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-8198
Mailing Address - Country:US
Mailing Address - Phone:812-477-1558
Mailing Address - Fax:812-488-2264
Practice Address - Street 1:225 CROSSLAKE DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8198
Practice Address - Country:US
Practice Address - Phone:812-477-1558
Practice Address - Fax:812-488-2264
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004200A2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0739010001OtherMEDICARE NSC
IL3200053OtherBCBS
IL087587OtherHEALTH ALLIANCE
ILP00079718OtherRR MEDICARE
IL0739010005OtherMEDICARE NSC
ILCD4744OtherRAILROAD MEDICARE GROUP #
IL036107136Medicaid
IL0739010006OtherMEDICARE NSC
IL0739010002OtherMEDICARE NSC
IL0739010008OtherMEDICARE NSC
ILCD4744OtherRAILROAD MEDICARE GROUP #
IL036107136Medicaid
IL3200053OtherBCBS
IL0739010006OtherMEDICARE NSC
IL370830Medicare ID - Type UnspecifiedLOCALITY 99