Provider Demographics
NPI:1770567661
Name:RAABE, JASON (PA-C)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:RAABE
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 1:457 THORBURN PL
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6847
Mailing Address - Country:US
Mailing Address - Phone:614-961-9958
Mailing Address - Fax:
Practice Address - Street 1:30 W MCCREIGHT AVE STE 106
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1853
Practice Address - Country:US
Practice Address - Phone:937-523-9820
Practice Address - Fax:937-523-9829
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-03
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002026363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH373855OtherANTHEM
OH373855OtherANTHEM