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Individual
JASON K FOGG
Active
Individual
JASON K FOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
OT012163
PA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
03504
KY
Other
Enumeration date
02/10/2009
Last updated
11/05/2020
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