Healthcare Provider Details

I. General information

NPI: 1700806486
Provider Name (Legal Business Name): JASON DREW SCHOFIELD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W GRAND AVE STE 3003
DAYTON OH
45405-4722
US

IV. Provider business mailing address

425 W GRAND AVE STE 3003
DAYTON OH
45405-4722
US

V. Phone/Fax

Practice location:
  • Phone: 937-643-9299
  • Fax: 937-643-2343
Mailing address:
  • Phone: 937-643-9299
  • Fax: 937-643-2343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50001394
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number50.001394
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: