Individual
DR. JASON E MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 AUDUBON PLAZA DR, LOUISVILLE, KY 40217-1318
(502) 634-6767
(502) 634-6775
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6218
(502) 588-9494
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34956
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000786858
ANTHEM BC/BS
KY
05
—
200266300
—
IN
01
—
34956
KY MEDICAID
KY
01
—
50042930
PASSPORT
KY
05
—
64004922
—
KY
Enumeration date
09/01/2006
Last updated
09/06/2023
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