Individual
DR. JASON K HASLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9850 W ST LUKES DR STE 215, NAMPA, ID 83687-7912
(208) 706-2663
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
40324
TN
207XS0106X
Orthopaedic Hand Surgery Physician
40324
TN
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
MC-2569
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1511195
—
TN
05
—
3816037
—
TN
01
—
4129574
BCBS
TN
01
—
4207969
BCBS
TN
01
—
4351528
BCBS TN
TN
05
—
7100190980
—
KY
Enumeration date
07/01/2006
Last updated
11/27/2024
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