Provider Demographics
NPI:1306874466
Name:MCALLASTER, JASON J (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:J
Last Name:MCALLASTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N MAPLE ST
Mailing Address - Street 2:P O BOX 1268
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2003
Mailing Address - Country:US
Mailing Address - Phone:217-342-4151
Mailing Address - Fax:217-342-4190
Practice Address - Street 1:300 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2003
Practice Address - Country:US
Practice Address - Phone:217-342-4151
Practice Address - Fax:217-342-4190
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123385208600000X
MO2006012811208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036123385Medicaid
IL1952304412OtherMARSHALL CLINIC EFFINGHAM, SC GROUP PRACTICE NPI
ILI56354Medicare UPIN