Provider Demographics
NPI:1801970215
Name:KOSKINEN, JASON A (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:KOSKINEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WILFORD HALL
Mailing Address - Street 2:1100 WILFORD HALL LOOP
Mailing Address - City:JBSA LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236
Mailing Address - Country:US
Mailing Address - Phone:609-741-9695
Mailing Address - Fax:
Practice Address - Street 1:WILFORD HALL
Practice Address - Street 2:1100 WILFORD HALL LOOP
Practice Address - City:JBSA LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:609-741-9695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine