MEDICARE: MR. JASON D OAKES 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
1	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant	10702	MN

General Provider Information

NPI Number	:	1720310766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON D OAKES PA-C

Provider Business Mailing Address
First Line	:	500 N 5TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-1206
Country	:	US
Telephone Number	:	763-290-4073
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N 5TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-1206
Country	:	US
Telephone Number	:	763-290-4073
Fax Number	:

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

Provider Enumeration Date	:	02/02/2010
Last Update Date	:	09/15/2022

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