Provider Demographics
NPI:1659351419
Name:MECKLER, JASON MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:MECKLER
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:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-450-7338
Mailing Address - Fax:812-450-2193
Practice Address - Street 1:600 MARY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1674
Practice Address - Country:US
Practice Address - Phone:812-450-7338
Practice Address - Fax:812-450-2193
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076319A2084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000057058FOtherHUMANA - NNS
KY0474086OtherCIGNA - NNS
KY119122OtherSIHO - NNS
KY50030793OtherPASSPORT/PASSPORT ADVANTAGE - NNS
KY000000693358OtherANTHEM - NNS
KY64107592Medicaid
KYI 38140Medicare UPIN
KY64107592Medicaid
KY00546129Medicare PIN
KY119122OtherSIHO - NNS
KY000057058FOtherHUMANA - NNS