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NPI Code Detail

MEDICARE: JASON TACKETT D.O.

MEDICARE:   JASON  TACKETT  D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician34008287OH

General Provider Information

NPI Number : 1043326580
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON TACKETT D.O.
Provider Business Mailing Address
First Line : 6400 ATLANTIC BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32211-8768
Country : US
Telephone Number : 866-638-5931
Fax Number : 904-805-1456
Provider Business Practice Location Address
First Line : 1997 MIAMISBURG CENTERVILLE RD
Second Line :
City : DAYTON
State : OH
Zip : 45459-3811
Country : US
Telephone Number : 800-514-1494
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/09/2007

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Directions to “ JASON TACKETT D.O.” Practice Location

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