Provider Demographics
NPI:1912938234
Name:VANCE, JASON R (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:VANCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7586 CATCHFLY DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-1725
Mailing Address - Country:US
Mailing Address - Phone:530-966-5454
Mailing Address - Fax:530-872-6653
Practice Address - Street 1:7586 CATCHFLY DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-1725
Practice Address - Country:US
Practice Address - Phone:530-966-5454
Practice Address - Fax:530-872-6653
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA60594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01920ZOtherBLUE SHIELD
CAG76345Medicare UPIN
CAZZZ01920ZOtherBLUE SHIELD