Individual
MR. JASON ERIC BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2110 CAROLINA AVE SW FL 3, ROANOKE, VA 24014-1742
(540) 777-1711
(540) 777-1713
Mailing address
3825 ELECTRIC RD STE C, 419 OFFICE CENTER, ROANOKE, VA 24018-4561
(540) 777-1711
(540) 777-1713
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002428
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760567481
—
VA
Enumeration date
10/25/2006
Last updated
07/10/2020
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