Healthcare Provider Details

I. General information

NPI: 1457527772
Provider Name (Legal Business Name): JASON MICHAEL POSTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 E SUNNYSIDE RD SUITE 'J'
IDAHO FALLS ID
83404-8280
US

IV. Provider business mailing address

2375 E SUNNYSIDE RD SUITE 'J'
IDAHO FALLS ID
83404-8280
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-7246
  • Fax: 208-529-2620
Mailing address:
  • Phone: 208-522-7246
  • Fax: 208-529-2620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberM-11061
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number7257910-1205
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR1476
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: