Provider Demographics
NPI:1851658538
Name:SIEGEL, JASON (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SIEGEL
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 1:4110 SOUTHPOINT BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0925
Mailing Address - Country:US
Mailing Address - Phone:904-544-5350
Mailing Address - Fax:904-659-7325
Practice Address - Street 1:4110 SOUTHPOINT BLVD STE 104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0925
Practice Address - Country:US
Practice Address - Phone:904-544-5350
Practice Address - Fax:904-659-7325
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1171982084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology