Individual
JASON T. GAISFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1721 MAGNAVOX WAY, FORT WAYNE, IN 46804-1537
(260) 748-3651
(260) 748-3651
Mailing address
PO BOX 670, HUNTERTOWN, IN 46748-0670
(260) 748-3650
(260) 748-3651
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001602A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300006158
—
IN
Enumeration date
09/18/2013
Last updated
08/23/2019
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