Provider Demographics
NPI:1588871859
Name:PICCONI, JASON LEWIS (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEWIS
Last Name:PICCONI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-6888
Mailing Address - Fax:515-643-6899
Practice Address - Street 1:5901 WESTOWN PKWY STE 225
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8297
Practice Address - Country:US
Practice Address - Phone:515-643-6888
Practice Address - Fax:515-643-6899
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA38889207SG0201X
IAMD-38889207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology