# DR. JASON ROBERT CROAD

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1992083778
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 1033 | NE | — |
| 207Q00000X | Family Medicine Physician | OS019536 | PA | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | NULL | — |

## Other

- **Enumeration date:** 07/28/2011
- **Last updated:** 12/03/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1035497850001 | — | PA |