Provider Demographics
NPI:1982804670
Name:ROOF, JASON GLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:GLEN
Last Name:ROOF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2230 STOCKTON BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1419
Mailing Address - Country:US
Mailing Address - Phone:916-734-0870
Mailing Address - Fax:916-451-9946
Practice Address - Street 1:2230 STOCKTON BLVD FL 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1419
Practice Address - Country:US
Practice Address - Phone:916-734-0870
Practice Address - Fax:916-451-9946
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA994042084P0800X
TXM20582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry