Provider Demographics
NPI:1881866572
Name:EVERMAN, JASON W (DO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:W
Last Name:EVERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2790
Mailing Address - Country:US
Mailing Address - Phone:317-355-7199
Mailing Address - Fax:317-355-9022
Practice Address - Street 1:7910 E WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-6803
Practice Address - Country:US
Practice Address - Phone:317-355-7171
Practice Address - Fax:317-355-9022
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN11013878A207Q00000X
IN02003712A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01347702OtherMEDICARE RR
IN201014320Medicaid
INM400040920Medicare PIN
IN266180366Medicare PIN