Provider Demographics
NPI:1902689391
Name:THOMAS, JASON ALLEN
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALLEN
Last Name:THOMAS
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 1:260 MALLARD POINT DR APT 309
Mailing Address - Street 2:
Mailing Address - City:COVENTRY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44319-5757
Mailing Address - Country:US
Mailing Address - Phone:234-567-3133
Mailing Address - Fax:
Practice Address - Street 1:24 S WEBER ST STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1928
Practice Address - Country:US
Practice Address - Phone:866-226-8576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic