Provider Demographics
NPI:1790744316
Name:AASE, JON M (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:M
Last Name:AASE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5356
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:201 CEDAR ST SE
Practice Address - Street 2:PRESBYTERIAN HOSPITAL PICU
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4917
Practice Address - Country:US
Practice Address - Phone:505-841-1163
Practice Address - Fax:505-222-2696
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2008-07-17
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Provider Licenses
StateLicense IDTaxonomies
NM751208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14712Medicaid
$$$$$$$$$MMedicare PIN
NM14712Medicaid