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General NPI Number Information
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NPI Number | 1043771207
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Entity Type | Individual
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Provider Name | JEFFERSON WASSON DO
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Gender | Male
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 506 LAKE ST
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City | KENAI
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State | AK
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Zip | 99611-6937
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Country | US
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Telephone | 907-714-4025
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Fax | 844-412-3952
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Provider Business Mailing Address
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Address Line | 250 HOSPITAL PL
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City | SOLDOTNA
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State | AK
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Zip | 99669-6999
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Country | US
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Telephone | 907-714-4038
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Fax | 907-262-5191
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 189244
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License Number State | AK
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