Provider Demographics
NPI:1205008109
Name:BILLINGHURST, JASON (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BILLINGHURST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 N CONGRESS AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3209
Mailing Address - Country:US
Mailing Address - Phone:561-725-0540
Mailing Address - Fax:
Practice Address - Street 1:4631 N CONGRESS AVE STE 205
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3209
Practice Address - Country:US
Practice Address - Phone:561-725-0540
Practice Address - Fax:866-950-0297
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114075207XS0117X
GA63563207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME114075OtherFLORIDA MEDICAL LICENSE
CAA103225OtherCA LIIC.
FLME114075OtherFLORIDA MEDICAL LICENSE
FL1528174430Medicare PIN