Provider Demographics
NPI:1962425660
Name:WESLEY, JASON ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALLEN
Last Name:WESLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 SUNSET DR STE A
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5406
Mailing Address - Country:US
Mailing Address - Phone:928-660-6960
Mailing Address - Fax:928-660-6959
Practice Address - Street 1:210 SUNSET DR STE A
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5406
Practice Address - Country:US
Practice Address - Phone:928-660-6960
Practice Address - Fax:928-660-6959
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26831207Q00000X, 207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ944555Medicaid
AZ944555Medicaid