Provider Demographics
NPI:1215327952
Name:STAHELI, JASON M (PA-C)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:M
Last Name:STAHELI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5444 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5632
Mailing Address - Country:US
Mailing Address - Phone:801-313-4140
Mailing Address - Fax:
Practice Address - Street 1:3903 HARRISON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2361
Practice Address - Country:US
Practice Address - Phone:801-387-8900
Practice Address - Fax:801-387-8920
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT9291078-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant