Provider Demographics
NPI:1063174985
Name:MCCARTY, JASON LESLIE (CG61021888)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LESLIE
Last Name:MCCARTY
Suffix:
Gender:M
Credentials:CG61021888
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N MONROE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2148
Mailing Address - Country:US
Mailing Address - Phone:509-413-2950
Mailing Address - Fax:509-241-1866
Practice Address - Street 1:901 N MONROE ST STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2148
Practice Address - Country:US
Practice Address - Phone:509-413-2950
Practice Address - Fax:509-241-1866
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61021888175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty