Individual
DR. JASON D DEDOES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
213 FAIRVIEW BLVD, KENDALLVILLE, IN 46755-2988
(260) 347-2833
(260) 668-7563
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
07001105A
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
T13-2008
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201002160
—
IN
Enumeration date
12/02/2008
Last updated
10/20/2022
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