Provider Demographics
NPI:1639459068
Name:KANE, JASON K (DPM)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:K
Last Name:KANE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 DAVIS TEE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6024
Mailing Address - Country:US
Mailing Address - Phone:307-461-7097
Mailing Address - Fax:
Practice Address - Street 1:132 N GOULD ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3928
Practice Address - Country:US
Practice Address - Phone:307-672-3457
Practice Address - Fax:307-674-1527
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY146213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery