Provider Demographics
NPI:1184753485
Name:CRAFT, JASON A (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:CRAFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1325 E FORTIFICATION ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2442
Mailing Address - Country:US
Mailing Address - Phone:601-949-9106
Mailing Address - Fax:601-914-1835
Practice Address - Street 1:1325 E FORTIFICATION ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2442
Practice Address - Country:US
Practice Address - Phone:601-354-4488
Practice Address - Fax:601-960-4586
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS19184207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1184753485OtherNPI
512G700003OtherUP MEDICARE PTAN
MS00624501Medicaid
MSP00619788OtherRAILROAD MEDICARE PTAN
MS512I200016OtherM'CARE PTAN
MSP00621369OtherRAILROAD MEDICARE PTAN-GROUP#CC1164