Provider Demographics
NPI:1710969217
Name:MANUEL, JASON (DPM)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:MANUEL
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 1:13400 SUTTON PARK DR S
Mailing Address - Street 2:SUITE 1103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0236
Mailing Address - Country:US
Mailing Address - Phone:904-223-8818
Mailing Address - Fax:904-223-6969
Practice Address - Street 1:13400 SUTTON PARK DR S
Practice Address - Street 2:SUITE 1103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0236
Practice Address - Country:US
Practice Address - Phone:904-223-8818
Practice Address - Fax:904-223-6969
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2551213E00000X
FLP02551213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480031776OtherRR MEDICARE
FL390397400Medicaid
FL65442OtherBLUE CROSS
FL4257970001Medicare NSC
FL390397400Medicaid
FL65442OtherBLUE CROSS