Provider Demographics
NPI:1245339019
Name:MCNAUGHTEN, JASON SAMUEL (CPO CERT PROSTH/ORTH)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:SAMUEL
Last Name:MCNAUGHTEN
Suffix:
Gender:M
Credentials:CPO CERT PROSTH/ORTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87067
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304
Mailing Address - Country:US
Mailing Address - Phone:910-323-9016
Mailing Address - Fax:910-486-8712
Practice Address - Street 1:234 OWEN DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-323-9016
Practice Address - Fax:910-486-8712
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCPO02333224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795107Medicaid