MEDICARE: WILLIAM JASON P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	11102	CA

General Provider Information

NPI Number	:	1144252230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JASON P.A.

Provider Business Mailing Address
First Line	:	4 MICHENER LN
Second Line	:
City	:	COTO DE CAZA
State	:	CA
Zip	:	92679-5154
Country	:	US
Telephone Number	:	949-589-3346
Fax Number	:	949-589-3346

Provider Business Practice Location Address
First Line	:	2362 MORSE AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-6234
Country	:	US
Telephone Number	:	949-863-9103
Fax Number	:	949-863-1337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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