Provider Demographics
NPI:1902957665
Name:DIFUSCO, JASON CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHRISTIAN
Last Name:DIFUSCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 PATHWAY PL
Mailing Address - Street 2:APT. B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2324
Mailing Address - Country:US
Mailing Address - Phone:832-392-0527
Mailing Address - Fax:
Practice Address - Street 1:2451 FILLINGIM STREET, MSTN 611
Practice Address - Street 2:HOUSESTAFF OFFICE
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617
Practice Address - Country:US
Practice Address - Phone:251-471-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program