Healthcare Provider Details

I. General information

NPI: 1689838492
Provider Name (Legal Business Name): JASON A HAMPTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E COTTAGE GROVE RD
COTTAGE GROVE WI
53527-9619
US

IV. Provider business mailing address

3051 CAHILL MAIN
FITCHBURG WI
53711-7109
US

V. Phone/Fax

Practice location:
  • Phone: 608-839-3515
  • Fax: 608-839-3541
Mailing address:
  • Phone: 608-661-7200
  • Fax: 608-661-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55870-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: