Provider Demographics
NPI:1861501694
Name:STINNETT, JASON M (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:STINNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1121 E 3900 S
Mailing Address - Street 2:SUITE C-240
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1214
Mailing Address - Country:US
Mailing Address - Phone:801-262-9494
Mailing Address - Fax:801-266-2074
Practice Address - Street 1:1492 W ANTELOPE DR
Practice Address - Street 2:SUITE 125
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1139
Practice Address - Country:US
Practice Address - Phone:801-525-3022
Practice Address - Fax:801-775-9508
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2016-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM9050207RH0003X
UT379443-1205207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00388855OtherRAILROAD MEDICARE
UT107055831101OtherSELECT HEALTH
UTQMP000003378087OtherMOLINA
UT107055831101OtherSELECT HEALTH
UTQMP000003378087OtherMOLINA