Provider Demographics
NPI:1447291745
Name:YAX, JASON MATTHEW (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MATTHEW
Last Name:YAX
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 QUARRY CREST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-4971
Mailing Address - Country:US
Mailing Address - Phone:614-753-9809
Mailing Address - Fax:
Practice Address - Street 1:3525 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 4330
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3937
Practice Address - Country:US
Practice Address - Phone:614-255-6900
Practice Address - Fax:614-255-6901
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 10714207R00000X
OH34.010931207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS 10714OtherMEDICAL LICENSE
FLOS 10714OtherMEDICAL LICENSE
MII54708Medicare UPIN
OHH327150Medicare PIN