Basic Information
| Provider Information | |||||||||
| NPI: | 1255365227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DZIAK | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 BILTMORE AVE | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282132250 | ||||||||
| FaxNumber: | 8282132395 | ||||||||
| Practice Location | |||||||||
| Address1: | 509 BILTMORE AVE | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282132250 | ||||||||
| FaxNumber: | 8282132395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 11/06/2018 | ||||||||
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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 | 207L00000X | 2008-00095 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00026150501 | 01 | NY | UNIVERA PROV# | OTHER | 2222 | 01 | NY | BLUE SHIELD GROUP# | OTHER | 00372225 | 05 | NY | MEDICAID | 050081548 | 01 | NY | RAILROAD MEDICARE# | OTHER | P010221884 | 01 | NY | BLUE CHOICE PROV# | OTHER | MDG325 | 01 | NY | PREFERRED CARE | OTHER | 7341237 | 01 | NY | AETNA | OTHER | G0189393590 | 01 | NY | BLUE CHOICE GROUP# | OTHER | 02168069 | 05 | NY | MEDICAID |