Healthcare Provider Details

I. General information

NPI: 1033191200
Provider Name (Legal Business Name): JASON JAMES RASMUSSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 28TH ST SUITE 300
MINNEAPOLIS MN
55407-1139
US

IV. Provider business mailing address

8351 AMSDEN RIDGE DR
BLOOMINGTON MN
55438-1414
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-6800
  • Fax:
Mailing address:
  • Phone: 916-709-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA88529
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number43356
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number60101
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43356
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: