Individual
MR. JASON GARY LUNSFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1040 GULF BREEZE PKWY, SUITE 200, GULF BREEZE, FL 32561-7809
(850) 916-3700
(850) 916-3710
Mailing address
PO BOX 30532, PENSACOLA, FL 32503-1532
(850) 478-1312
(850) 474-9060
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9108485
FL
363AM0700X
Medical Physician Assistant
1073878
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014787900
—
FL
05
—
172374
—
AL
01
—
593-16867
BLUE CROSS BLUE SHIELD
AL
01
—
Y0R57
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/24/2007
Last updated
05/31/2016
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