Basic Information
| Provider Information | |||||||||
| NPI: | 1588673032 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRANKLIN | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | TYLER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 CROSSLAKE DR | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477158198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124771558 | ||||||||
| FaxNumber: | 8124882264 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 CROSSLAKE DR | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477158198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124771558 | ||||||||
| FaxNumber: | 8124882264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 02004200A | IN | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0739010001 | 01 | IL | MEDICARE NSC | OTHER | 3200053 | 01 | IL | BCBS | OTHER | 087587 | 01 | IL | HEALTH ALLIANCE | OTHER | P00079718 | 01 | IL | RR MEDICARE | OTHER | 0739010005 | 01 | IL | MEDICARE NSC | OTHER | CD4744 | 01 | IL | RAILROAD MEDICARE GROUP # | OTHER | 036107136 | 05 | IL | MEDICAID | 0739010006 | 01 | IL | MEDICARE NSC | OTHER | 0739010002 | 01 | IL | MEDICARE NSC | OTHER | 0739010008 | 01 | IL | MEDICARE NSC | OTHER |