Provider Demographics
NPI:1316977796
Name:MCKEOWN, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MCKEOWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24351207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009999925Medicaid
AL051537684OtherBCBS
AL010033CI30447OtherSECTION 1011
AL009939938Medicaid
AL051528646OtherBLUE CROSS
AL009999915Medicaid
AL051528644OtherBLUE CROSS
AL009999905Medicaid
MS09682813Medicaid
AL051528647OtherBLUE CROSS
AL051528646OtherBLUE CROSS
AL009999925Medicaid