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Individual

JASON CHAUNCEY SPENCER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
8761 PERIMETER PARK BLVD STE 106, JACKSONVILLE, FL 32216-6397
(904) 621-6628
(904) 346-0113
Mailing address
28 YACHTSMEN COURT, WOODBINE, GA 31569
(912) 541-0243

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
003768
GA
363A00000X
Physician Assistant
Primary
PA9103004
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100002298D
GA
05
100002298F
GA
01
10059208
AMERIGROUP
GA
Enumeration date
08/29/2006
Last updated
06/11/2008
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