Provider Demographics
NPI:1821289943
Name:WERTHEIM, JASON A (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:WERTHEIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 N CAMPBELL AVE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1454
Mailing Address - Country:US
Mailing Address - Phone:520-626-2729
Mailing Address - Fax:
Practice Address - Street 1:3838 N CAMPBELL AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1454
Practice Address - Country:US
Practice Address - Phone:520-626-2729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128678204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABX398ZMedicare PIN