Provider Demographics
NPI:1427137991
Name:SU, JASON T (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:SU
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1055 N 300 W STE 311
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3373
Mailing Address - Country:US
Mailing Address - Phone:385-477-6800
Mailing Address - Fax:385-477-6801
Practice Address - Street 1:1055 N 300 W STE 311
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3373
Practice Address - Country:US
Practice Address - Phone:385-477-6800
Practice Address - Fax:385-477-6801
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2024-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEDO39742080P0202X
UT5665627-12042080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology