MEDICARE: DR. JASON MICHAEL MEHRTENS MD

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
1	207QA0505X	Adult Medicine Physician	2010009950	MO

General Provider Information

NPI Number	:	1194772129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON MICHAEL MEHRTENS MD

Provider Business Mailing Address
First Line	:	1203 SMIZER MILL RD STE 105
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-3483
Country	:	US
Telephone Number	:	636-717-1350
Fax Number	:	636-717-1355

Provider Business Practice Location Address
First Line	:	1203 SMIZER MILL RD STE 105
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-3483
Country	:	US
Telephone Number	:	636-717-1350
Fax Number	:	636-717-1355

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	09/13/2018

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