Provider Demographics
NPI:1649531401
Name:ASISTORES, JASON (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ASISTORES
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 1:15 TERRY CT STE E
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2568
Mailing Address - Country:US
Mailing Address - Phone:540-328-2871
Mailing Address - Fax:540-675-4004
Practice Address - Street 1:15 TERRY CT STE E
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2568
Practice Address - Country:US
Practice Address - Phone:540-328-2871
Practice Address - Fax:540-675-4004
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT200875207Q00000X
VA0101258210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1649531401Medicaid