MEDICARE: JASON EDWARD GUEVARA M.D.

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	207X00000X	Orthopaedic Surgery Physician	9901414	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200039797	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	12586	OTHER		BCBS NC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689680787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON EDWARD GUEVARA M.D.

Provider Business Mailing Address
First Line	:	4208 MURDOCKSVILLE RD
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-8871
Country	:	US
Telephone Number	:	910-295-7070
Fax Number	:	910-295-7447

Provider Business Practice Location Address
First Line	:	4208 MURDOCKSVILLE RD
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-8871
Country	:	US
Telephone Number	:	910-295-7070
Fax Number	:	910-295-7447

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	04/07/2016

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