Provider Demographics
NPI:1922311893
Name:WEBB, JASON WHITLEY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:WHITLEY
Last Name:WEBB
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MEDICAL GROUP UNIT 14010 ANDERSEN AFB
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96544
Mailing Address - Country:US
Mailing Address - Phone:671-366-9355
Mailing Address - Fax:
Practice Address - Street 1:36TH MEDICAL GROUP UNIT 14010
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96544-4010
Practice Address - Country:US
Practice Address - Phone:671-366-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1922311893Medicaid