Provider Demographics
NPI:1255566311
Name:DETERMANN, JASON ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ROBERT
Last Name:DETERMANN
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:PO BOX 1186
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-1186
Mailing Address - Country:US
Mailing Address - Phone:251-928-2401
Mailing Address - Fax:251-928-5099
Practice Address - Street 1:341 GREENO RD N
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2979
Practice Address - Country:US
Practice Address - Phone:251-928-2401
Practice Address - Fax:251-928-5099
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30613207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2084Medicaid
NCNCH954AMedicare PIN
NC0397730007Medicare NSC
NC1255566311Medicaid