Provider Demographics
NPI:1851581789
Name:PETER, JASON N (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:N
Last Name:PETER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 CROOKS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3620
Mailing Address - Country:US
Mailing Address - Phone:586-977-7246
Mailing Address - Fax:
Practice Address - Street 1:2885 E LONG LAKE RD STE A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-4100
Practice Address - Country:US
Practice Address - Phone:248-266-9137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014928208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation