MEDICARE: JASON D LARSON D.P.M.

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	213E00000X	Podiatrist	25MD00247600	NJ
2	213ES0131X	Foot Surgery Podiatrist	25MD00247600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215905203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON D LARSON D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 825159
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-5159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2159 ROUTE 88 E
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-3232
Country	:	US
Telephone Number	:	732-899-0015
Fax Number	:

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	01/12/2026

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