Basic Information
| Provider Information | |||||||||
| NPI: | 1205147659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROOS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 W ACEQUIA AVE STE 1B | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932916163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594094720 | ||||||||
| FaxNumber: | 5594094713 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 W 5TH AVE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098382531 | ||||||||
| FaxNumber: | 5097556580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2010 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YS0123X | OP60519665 | WA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | 207YS0123X | 5101018567 | MI | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | 207YS0123X | 20A18178 | CA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery |
No ID Information.