Individual
DR. JASON DEFATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1800 12TH ST, MERIDIAN, MS 39301-4158
(601) 484-6700
Mailing address
PO BOX 5183, MERIDIAN, MS 39302-5183
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
02086755
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02086755
—
MS
Enumeration date
02/28/2014
Last updated
08/04/2020
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