Individual
DR. JASON DAVID FODEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7273 LINDERSON WAY SW, TUMWATER, WA 98501-5414
(360) 902-5511
Mailing address
PO BOX 44321, OLYMPIA, WA 98504-4321
(360) 902-5511
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD456893
PA
Other
Enumeration date
09/14/2009
Last updated
01/17/2020
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