Provider Demographics
NPI:1912016700
Name:DOMINITZ, JASON ALAN (MD, MHS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALAN
Last Name:DOMINITZ
Suffix:
Gender:M
Credentials:MD, MHS
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Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:VA PUGET SOUND HEALTH CARE SYSTEM (111-S-GASTRO)
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-277-3558
Mailing Address - Fax:206-764-2232
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:VA PUGET SOUND HEALTH CARE SYSTEM (111-S-GASTRO)
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-277-3558
Practice Address - Fax:206-764-2232
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WAMD00035341207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG64844Medicare UPIN