Provider Demographics
NPI:1821008566
Name:JONASON, SCOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:JONASON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 N ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2616
Mailing Address - Country:US
Mailing Address - Phone:480-677-8282
Mailing Address - Fax:
Practice Address - Street 1:19550 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-2077
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7804363AM0700X
WAPA10003185363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8354466Medicaid
AZ098653Medicaid
WA8354466Medicaid