Provider Demographics
NPI:1275330094
Name:BLOSSER, JASON (RDMS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BLOSSER
Suffix:
Gender:
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 BOARDMAN CANFIELD RD STE A1
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4384
Mailing Address - Country:US
Mailing Address - Phone:844-696-2229
Mailing Address - Fax:
Practice Address - Street 1:755 BOARDMAN CANFIELD RD STE A1
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4384
Practice Address - Country:US
Practice Address - Phone:844-696-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1677342085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound