Provider Demographics
NPI:1740439769
Name:GIPSON, JASON L (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:L
Last Name:GIPSON
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 1:312 9TH ST SW STE 1200
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2998
Mailing Address - Country:US
Mailing Address - Phone:319-352-4340
Mailing Address - Fax:
Practice Address - Street 1:312 9TH ST SW STE 1200
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2998
Practice Address - Country:US
Practice Address - Phone:319-352-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA50627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EX301OtherBCBS
TX75-2616977-020OtherTRICARE
TXP01439635OtherRAIL ROAD MEDICARE
TXP01439635OtherRAIL ROAD MEDICARE