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Individual

JASON MATTHEW LODEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
1333 S SAM HOUSTON BLVD STE C, HOUSTON, MO 65483-2046
(417) 967-1252
(417) 967-0417
Mailing address
1333 S SAM HOUSTON BLVD STE C, HOUSTON, MO 65483-2046
(417) 967-1252
(417) 967-0417

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2018007730
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
152250019
MEDICARE PART B
MO
05
200054452
MO
Enumeration date
07/03/2013
Last updated
10/26/2023
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