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General NPI Number Information
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NPI Number | 1598020174
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Entity Type | Individual
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Provider Name | JASON DOUGLAS MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 3500 FRANCISCAN WAY STE 3A
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-0033
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Country | US
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Telephone | 219-861-8828
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Fax | 219-861-8827
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Provider Business Mailing Address
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Address Line | 7895 GRAND BLVD
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City | HOBART
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State | IN
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Zip | 46342-6665
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Country | US
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Telephone | 219-947-1910
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Fax | 219-947-3117
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036150263
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301101431
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License Number State | MI
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