Provider Demographics
NPI:1982615381
Name:BURNS, JASON LANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LANE
Last Name:BURNS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 LAUREL RUN DR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8372
Mailing Address - Country:US
Mailing Address - Phone:352-873-7723
Mailing Address - Fax:
Practice Address - Street 1:2023 LAUREL RUN DR
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8372
Practice Address - Country:US
Practice Address - Phone:352-873-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7025103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99267OtherBCBS
FL75097OtherBCBS
FLK8115Medicare PIN
FLAD276ZMedicare Oscar/Certification
FLP00462800Medicare PIN