Provider Demographics
NPI:1992130181
Name:HALL, JASON MICHAEL (CSA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:HALL
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7385 S PECOS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3768
Mailing Address - Country:US
Mailing Address - Phone:702-463-3300
Mailing Address - Fax:
Practice Address - Street 1:7385 S PECOS RD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3768
Practice Address - Country:US
Practice Address - Phone:702-463-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical