Provider Demographics
NPI:1295797934
Name:POLONSKY, JASON (PA)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:POLONSKY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:625 S GILBERT ST
Mailing Address - Street 2:STE 2
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-1736
Mailing Address - Country:US
Mailing Address - Phone:319-688-7376
Mailing Address - Fax:319-358-2628
Practice Address - Street 1:500 E MARKET ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2633
Practice Address - Country:US
Practice Address - Phone:319-339-0300
Practice Address - Fax:319-358-2783
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001465363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P81655Medicare UPIN