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NPI Code Detail

MEDICARE: JASON PATRICK WISSINGER MD

MEDICARE: JASON PATRICK WISSINGER MD
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
1207Q00000XFamily Medicine Physician173T2WY
2207Q00000XFamily Medicine PhysicianMED-PHYS-LIC-128574MT

General Provider Information

NPI Number : 1639297674
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON PATRICK WISSINGER MD
Provider Business Mailing Address
First Line : PO BOX 12
Second Line :
City : LIBERTY LAKE
State : WA
Zip : 99019-0012
Country : US
Telephone Number : 866-747-2455
Fax Number : 406-329-2659
Provider Business Practice Location Address
First Line : 3075 N RESERVE ST STE Q
Second Line :
City : MISSOULA
State : MT
Zip : 59808-1390
Country : US
Telephone Number : 406-327-1850
Fax Number : 406-327-1875
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2007
Last Update Date : 09/07/2023

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Directions to “ JASON PATRICK WISSINGER MD” Practice Location

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