Individual
JASON ERIC WALLENTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
245 N BINKLEY ST STE 101, SOLDOTNA, AK 99669-7500
(907) 714-4111
Mailing address
221 N CELIA AVE, MUNCIE, IN 47303-4609
(765) 747-3141
(765) 741-2977
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01085823A
IN
Other
Enumeration date
04/12/2019
Last updated
08/15/2022
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