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General NPI Number Information
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NPI Number | 1255566311
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Entity Type | Individual
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Provider Name | JASON ROBERT DETERMANN MD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 341 GREENO RD N
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City | FAIRHOPE
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State | AL
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Zip | 36532-2979
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Country | US
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Telephone | 251-928-2401
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Fax | 251-928-5099
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Provider Business Mailing Address
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Address Line | PO BOX 1186
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City | FAIRHOPE
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State | AL
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Zip | 36533-1186
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Country | US
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Telephone | 251-928-2401
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Fax | 251-928-5099
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 30613
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 30613
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License Number State | AL
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