Healthcare Provider Details

I. General information

NPI: 1770567661
Provider Name (Legal Business Name): JASON RAABE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2005
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MCCREIGHT AVE STE 106
SPRINGFIELD OH
45504-1853
US

IV. Provider business mailing address

457 THORBURN PL
GAHANNA OH
43230-6847
US

V. Phone/Fax

Practice location:
  • Phone: 937-523-9820
  • Fax: 937-523-9829
Mailing address:
  • Phone: 614-961-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50002026
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: