Provider Demographics
NPI:1598714750
Name:BEARDEN, JASON R (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:BEARDEN
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 1:208 MCFARLAND CIR N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1800
Mailing Address - Country:US
Mailing Address - Phone:205-345-7000
Mailing Address - Fax:205-343-0910
Practice Address - Street 1:208 MCFARLAND CIR N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1800
Practice Address - Country:US
Practice Address - Phone:205-345-7000
Practice Address - Fax:205-343-0910
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL243402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938064Medicaid
AL009938071Medicaid
AL009938068Medicaid
AL009938067Medicaid
AL009938066Medicaid
AL009938069Medicaid
AL009938059Medicaid
AL009938062Medicaid
AL009938063Medicaid
AL051557569Medicaid
AL009938061Medicaid
AZI44732Medicare UPIN
AL009938063Medicaid
AL051557569Medicaid