Provider Demographics
NPI:1326075342
Name:ALLEN, JASON W (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:W
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 ISLAND BOULEVARD FI
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333-9533
Mailing Address - Country:US
Mailing Address - Phone:253-282-5331
Mailing Address - Fax:
Practice Address - Street 1:714 N SENATE AVE STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3297
Practice Address - Country:US
Practice Address - Phone:317-963-0156
Practice Address - Fax:317-963-2711
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01091583A2084N0400X, 2085N0700X, 2085R0202X
WAMD 000479592085N0700X
NY2254792085N0700X
GA0693662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300081297Medicaid
IN1100023631OtherANTHEM PTAN