Provider Demographics
NPI:1700224201
Name:GASS, JASON JOHN (DO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:JOHN
Last Name:GASS
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 1:621 S NEW BALLAS RD STE 7018B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8256
Mailing Address - Country:US
Mailing Address - Phone:314-251-4949
Mailing Address - Fax:314-251-4368
Practice Address - Street 1:621 S NEW BALLAS RD STE 7018B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-4949
Practice Address - Fax:314-251-4368
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04881207R00000X
MO2018022314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine