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NPI Code Detail

MEDICARE: MR. FREDERICK JASON MCNEW PA-C

MEDICARE: MR. FREDERICK JASON MCNEW PA-C
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
1363AS0400XSurgical Physician AssistantPA9102191FL
2363A00000XPhysician AssistantPA9102191FL

Other Identifiers

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

General Provider Information

NPI Number : 1528021250
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. FREDERICK JASON MCNEW PA-C
Provider Business Mailing Address
First Line : 200 CORPORATE BLVD
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-3870
Country : US
Telephone Number : 800-893-9698
Fax Number :
Provider Business Practice Location Address
First Line : 922 E CALL ST
Second Line :
City : STARKE
State : FL
Zip : 32091-3616
Country : US
Telephone Number : 904-368-2300
Fax Number : 904-368-2306
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2006
Last Update Date : 05/14/2019

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