Provider Demographics
NPI:1336839679
Name:MITCHAM, JASON PAUL (CPED)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:PAUL
Last Name:MITCHAM
Suffix:
Gender:M
Credentials:CPED
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Other - Credentials:
Mailing Address - Street 1:4110 BRIARGATE PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7837
Mailing Address - Country:US
Mailing Address - Phone:719-867-7335
Mailing Address - Fax:719-632-0088
Practice Address - Street 1:COLORADO SPRINGS ORTHOPAEDIC GROUP DBA AUDUBON ORTHOTIC
Practice Address - Street 2:4110 BRIARGATE PARKWAY SUITE 300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7837
Practice Address - Country:US
Practice Address - Phone:719-632-7669
Practice Address - Fax:719-632-0088
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist