Basic Information
| Provider Information | |||||||||
| NPI: | 1538509484 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZELLER | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40,000 | ||||||||
| Address2: | ATTN: MEDICAL STAFF OFFICE | ||||||||
| City: | VAIL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704762451 | ||||||||
| FaxNumber: | 9704706458 | ||||||||
| Practice Location | |||||||||
| Address1: | MSC 11 6025 1 UNIVERSITY OF NEW MEXICO | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052725062 | ||||||||
| FaxNumber: | 5052726503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD2017-0420 | NM | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | MD2017-0420 | NM | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | DR.0065343 | CO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.