Provider Demographics
NPI:1285725481
Name:LINN, JASON (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 FROST VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2879
Mailing Address - Country:US
Mailing Address - Phone:301-268-3348
Mailing Address - Fax:
Practice Address - Street 1:1215 FRANCISCAN DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1778
Practice Address - Country:US
Practice Address - Phone:217-324-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI74160207P00000X
IL036145478207P00000X
MDD45774207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD053600800OtherRAILROAD MEDICARE
MDF84955Medicare UPIN
MDA149Medicare PIN