Individual
JASON MICHAEL VAN-BRUNT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
625 SW RAMSEY AVE, SUITE A, GRANTS PASS, OR 97527-5808
(541) 472-7956
Mailing address
2620 E BARNETT RD, #H, MEDFORD, OR 97504-8344
(541) 789-4281
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA166125
OR
Other
Enumeration date
09/18/2014
Last updated
09/18/2014
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