Provider Demographics
NPI:1952842353
Name:POSTLETHWAITE, JASON GEORGE (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:GEORGE
Last Name:POSTLETHWAITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-9608
Mailing Address - Country:US
Mailing Address - Phone:509-731-5069
Mailing Address - Fax:
Practice Address - Street 1:1210 W KENT AVE STE 202
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6612
Practice Address - Country:US
Practice Address - Phone:509-731-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT91284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine