Provider Demographics
NPI:1689680787
Name:GUEVARA, JASON EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:EDWARD
Last Name:GUEVARA
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 1:4208 MURDOCKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-8871
Mailing Address - Country:US
Mailing Address - Phone:910-295-7070
Mailing Address - Fax:910-295-7447
Practice Address - Street 1:4208 MURDOCKSVILLE RD
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-8871
Practice Address - Country:US
Practice Address - Phone:910-295-7070
Practice Address - Fax:910-295-7447
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901414207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200039797OtherRAILROAD MEDICARE
12586OtherBCBS NC
NC8912586Medicaid
200039797OtherRAILROAD MEDICARE
H12939Medicare UPIN