Provider Demographics
NPI:1700806486
Name:SCHOFIELD, JASON DREW (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DREW
Last Name:SCHOFIELD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W GRAND AVE STE 3003
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4722
Mailing Address - Country:US
Mailing Address - Phone:937-643-9299
Mailing Address - Fax:937-643-2343
Practice Address - Street 1:425 W GRAND AVE STE 3003
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4722
Practice Address - Country:US
Practice Address - Phone:937-643-9299
Practice Address - Fax:937-643-2343
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001394207RG0300X
OH50001394363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085647Medicaid
OHPA15154Medicare ID - Type Unspecified
OH0085647Medicaid
OHPA15158Medicare PIN