MEDICARE: DR. JASON K HASLAM 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	207XS0106X	Orthopaedic Hand Surgery Physician	MC-2569	ID
2	207X00000X	Orthopaedic Surgery Physician	40324	TN
3	207XS0106X	Orthopaedic Hand Surgery Physician	40324	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4129574	OTHER	TN	BCBS
2	4351528	OTHER	TN	BCBS TN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4207969	OTHER	TN	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417986688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON K HASLAM MD

Provider Business Mailing Address
First Line	:	190 E BANNOCK ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83712-6241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9850 W ST LUKES DR STE 215
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687-7912
Country	:	US
Telephone Number	:	208-706-2663
Fax Number	:

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	11/27/2024

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Directions to “ DR. JASON K HASLAM MD” Practice Location

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