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Individual
JASON S SO
Active
Individual
JASON S SO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036119919
IL
207Q00000X
Family Medicine Physician
Primary
63015-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508078643
BCBSWI
WI
05
—
1508078643
—
WI
01
—
SOJAS
MERCYCARE INSURANCE
WI
Enumeration date
05/03/2007
Last updated
08/29/2019
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