Provider Demographics
NPI:1356339295
Name:HARMON, JASON M (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:HARMON
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 1:74 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-9370
Mailing Address - Country:US
Mailing Address - Phone:205-814-9284
Mailing Address - Fax:205-814-9626
Practice Address - Street 1:7191 CAHABA VALLEY RD STE 300
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35242-6461
Practice Address - Country:US
Practice Address - Phone:205-995-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.42362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047876800Medicaid
FL1356339295OtherTRICARE
FLME85985OtherVHN
FL57728OtherBCBS
FLP00799014OtherRAILROAD
FLE8710YMedicare PIN
FLE8710YMedicare PIN