Provider Demographics
NPI:1194772129
Name:MEHRTENS, JASON MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:MEHRTENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1203 SMIZER MILL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3483
Mailing Address - Country:US
Mailing Address - Phone:636-717-1350
Mailing Address - Fax:636-717-1355
Practice Address - Street 1:1203 SMIZER MILL RD STE 105
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3483
Practice Address - Country:US
Practice Address - Phone:636-717-1350
Practice Address - Fax:636-717-1355
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2010009950207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine