Provider Demographics
NPI:1457437055
Name:JASON, MICHAEL KING (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KING
Last Name:JASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:455 PINELLAS ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3354
Mailing Address - Country:US
Mailing Address - Phone:727-445-1992
Mailing Address - Fax:727-445-1993
Practice Address - Street 1:8839 BRYAN DAIRY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1203
Practice Address - Country:US
Practice Address - Phone:727-394-1911
Practice Address - Fax:727-394-1986
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2015-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY136861174400000X
FLME122604207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01538265Medicaid
B19746Medicare UPIN
NY01538265Medicaid