Prudom, Jason Scott

Prudom, Jason Scott is an individual health care provider with primary practice located at 3201 S 16Th St Ste 2015 , Milwaukee WI 53215-4532. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Pulmonary Disease is his primary health care specialty. Prudom, Jason Scott can be contacted via phone (414) 649-3810.

Contact Information

Primary practice address
3201 S 16Th St Ste 2015 Milwaukee WI 53215-4532
Phone: (414) 649-3810
Fax: (262) 240-0841
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Critical Care Medicine 207RC0200X 63600-20 Wisconsin
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X 63600-20 Wisconsin

Profile Details

NPI number 1265775993
LBN Legal business name Prudom, Jason Scott
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 1st, 2013
Last updated Mar 25th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265775993 NPPES
Wisconsin MEDICAID 100042547

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