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General NPI Number Information
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NPI Number | 1528217320
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Entity Type | Individual
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Provider Name | JASON C MANN D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/17/2008
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 4950 NORTON HEALTHCARE BLVD STE 208
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City | LOUISVILLE
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State | KY
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Zip | 40241
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Country | US
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Telephone | 502-614-4179
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Fax | 502-614-4450
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 02004815A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 03604
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036120713
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 02004815A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 03604
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License Number State | KY
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