Provider Demographics
NPI:1770759490
Name:PARSON, JASON PAUL (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:PAUL
Last Name:PARSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NW 84TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1859
Mailing Address - Country:US
Mailing Address - Phone:954-475-9535
Mailing Address - Fax:954-475-4637
Practice Address - Street 1:350 NW 84TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1859
Practice Address - Country:US
Practice Address - Phone:954-475-9535
Practice Address - Fax:954-475-4637
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102964363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ26512Medicare UPIN