Provider Demographics
NPI:1144727694
Name:BRASE, JASON EDWARD
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:EDWARD
Last Name:BRASE
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:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0132
Mailing Address - Country:US
Mailing Address - Phone:541-773-7273
Mailing Address - Fax:541-773-2027
Practice Address - Street 1:1093 ROYAL CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6130
Practice Address - Country:US
Practice Address - Phone:541-773-7273
Practice Address - Fax:541-773-2027
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD209343207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology