Provider Demographics
NPI:1609829241
Name:COLINGER, JASON A (DO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:COLINGER
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:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650
Mailing Address - Country:US
Mailing Address - Phone:423-743-6141
Mailing Address - Fax:423-743-1083
Practice Address - Street 1:105 GAY ST
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650
Practice Address - Country:US
Practice Address - Phone:423-743-6141
Practice Address - Fax:423-743-1083
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000001654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI30644Medicare UPIN
TN3319333Medicare PIN