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General NPI Number Information
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NPI Number | 1609846062
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Entity Type | Individual
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Provider Name | JASON RANSOM M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 12563 STATE ROAD 23
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City | GRANGER
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State | IN
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Zip | 46530-9226
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Country | US
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Telephone | 574-335-8300
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Fax | 574-335-0775
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Provider Business Mailing Address
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Address Line | 707 CEDAR ST STE 405
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City | SOUTH BEND
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State | IN
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Zip | 46617-2059
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Country | US
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Telephone | 574-335-8707
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Fax |
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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 | 01059860A
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License Number State | IN
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