Provider Demographics
NPI:1295778330
Name:CHANDLER, JASON C (MD)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:C
Last Name:CHANDLER
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 1:7945 WOLF RIVER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-683-0055
Mailing Address - Fax:901-922-6701
Practice Address - Street 1:7945 WOLF RIVER BOULEVARD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-683-0055
Practice Address - Fax:901-922-6701
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21153207RX0202X
TN40867207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00860321OtherRR MEDICARE
AR1295778330Medicaid
TN3338904Medicaid
TN4267455OtherTN BCBS
MO1295778330Medicaid
MS02029582Medicaid
MO1295778330Medicaid
TN103I900603Medicare PIN
MS302I905068Medicare PIN