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General NPI Number Information
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NPI Number | 1083665699
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Entity Type | Individual
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Provider Name | JASON DOYLE RUNDELL PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVENUE
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City | TACOMA
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State | WA
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Zip | 98431
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Country | US
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Telephone | 253-968-1250
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Fax | 253-968-3190
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Provider Business Mailing Address
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Address Line | MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVENUE
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City | TACOMA
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State | WA
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Zip | 98431
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Country | US
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Telephone | 253-968-1250
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Fax | 253-968-3190
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA10003162
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License Number State | WA
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