Provider Demographics
NPI:1871699207
Name:MARIS, JASON E (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:E
Last Name:MARIS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:3950 MONTLAKE BLVD NE
Mailing Address - Street 2:ROOM 148
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-543-1552
Mailing Address - Fax:206-543-6573
Practice Address - Street 1:3950 MONTLAKE BLVD NE
Practice Address - Street 2:ROOM 148
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-1552
Practice Address - Fax:206-543-6573
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2013-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60310507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1871699207Medicaid