Provider Demographics
NPI:1710908447
Name:DOESCHER, JASON S (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:DOESCHER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:225 SMITH AVE N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2697
Mailing Address - Country:US
Mailing Address - Phone:651-241-5290
Mailing Address - Fax:651-241-5248
Practice Address - Street 1:225 SMITH AVE N
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2697
Practice Address - Country:US
Practice Address - Phone:651-241-5290
Practice Address - Fax:651-241-5248
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2019-08-15
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Provider Licenses
StateLicense IDTaxonomies
MN459612084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN754419700Medicaid
H92977Medicare UPIN
MN754419700Medicaid