Provider Demographics
NPI:1013981398
Name:SCHMIDTHUBER, JASON D (PA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:SCHMIDTHUBER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 S HOVER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7924
Mailing Address - Country:US
Mailing Address - Phone:303-645-4241
Mailing Address - Fax:720-790-7053
Practice Address - Street 1:1079 S HOVER ST STE 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7924
Practice Address - Country:US
Practice Address - Phone:303-645-4241
Practice Address - Fax:720-790-7053
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1646363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00384483OtherRR MEDICARE
CO90577710Medicaid
COP00384483OtherRR MEDICARE
COC803449Medicare PIN