Healthcare Provider Details

I. General information

NPI: 1639580376
Provider Name (Legal Business Name): JASON FRAMPTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N TOWNLINE RD STE 201
LAGRANGE IN
46761
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-347-2833
  • Fax: 260-347-1724
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number01081021A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: