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NPI Code Detail

MEDICARE: JASON M GROSDIDIER MD

MEDICARE:   JASON M GROSDIDIER  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
1207Q00000XFamily Medicine PhysicianMD00043600WA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01290278OTHERWARR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
20184960OTHERWAL&I
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972534832
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON M GROSDIDIER MD
Provider Business Mailing Address
First Line : 820 N CHELAN AVE
Second Line :
City : WENATCHEE
State : WA
Zip : 98801-2028
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 HIGHLINE DR
Second Line :
City : EAST WENATCHEE
State : WA
Zip : 98802-5341
Country : US
Telephone Number : 509-884-0614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 06/21/2022

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Directions to “ JASON M GROSDIDIER MD” Practice Location

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