Healthcare Provider Details

I. General information

NPI: 1861888240
Provider Name (Legal Business Name): JASON LOUIS ECCLESTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAYO ROCHESTER 200 FIRST STREET SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

MAYO ROCHESTER 200 FIRST STREET SW
ROCHESTER MN
55905-0001
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number66408-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT216096
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number69214
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: