Provider Demographics
NPI:1366522815
Name:WILTSHIRE, JASON P (MD)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:P
Last Name:WILTSHIRE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:514 CLEVELAND ST
Mailing Address - Street 2:MEDICAL PAVILION
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3562
Mailing Address - Country:US
Mailing Address - Phone:620-792-2151
Mailing Address - Fax:620-860-0305
Practice Address - Street 1:514 CLEVELAND ST
Practice Address - Street 2:MEDICAL PAVILION
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3562
Practice Address - Country:US
Practice Address - Phone:620-792-2151
Practice Address - Fax:620-860-0305
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-03-12
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Provider Licenses
StateLicense IDTaxonomies
KS04-33922208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H25806Medicare UPIN