Individual
JASON ALAN TIEDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1800 W 30TH ST, JOPLIN, MO 64804-1520
(417) 782-5000
(417) 782-2945
Mailing address
1800 W 30TH ST, JOPLIN, MO 64804-1520
(417) 782-5000
(417) 782-2945
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
117822
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000426956
BLUE CROSS BLUE SHIELD
KS
Enumeration date
07/31/2006
Last updated
07/08/2007
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