Provider Demographics
NPI:1992305700
Name:SCOLES, JASON PATRICK
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:PATRICK
Last Name:SCOLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 HICKAM DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1544
Mailing Address - Country:US
Mailing Address - Phone:614-216-8082
Mailing Address - Fax:
Practice Address - Street 1:5607 HICKAM DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431-1544
Practice Address - Country:US
Practice Address - Phone:614-216-8082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians