Provider Demographics
NPI:1013948215
Name:WILLIS, JASON (PA)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:WILLIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:522 W NEWTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2820
Mailing Address - Country:US
Mailing Address - Phone:724-853-8922
Mailing Address - Fax:724-853-8925
Practice Address - Street 1:522 W NEWTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2820
Practice Address - Country:US
Practice Address - Phone:724-853-8922
Practice Address - Fax:724-853-8925
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1438120OtherHIGHMARK BLUE SHIELD
242348OtherHEALTH AMERICA
970028289OtherRAILROAD MEDICARE
PA042268OtherHIGHMARK MEDICARE SERVICE
7659464OtherAETNA