| Doctor Name: | JASON NORBERT SUPPAN |
| NPI Number: | 1528059391 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 36-00-3017-S |
| Business Practice Address: | 1720 Paradise Rd Orrville, OH - 446679418 |
| Business Phone Number: | 3306826070 |
| Business Fax Number: | 3306842822 |
| Mailing Address: | Po Box 636, ORRVILLE |
| State: | OH |
| Postal Code: | 446670636 |
| Phone Number: | 3306826070 |
| Fax Number: | 3306842822 |
| NPI Enumeration Date: | 11/02/2005 |
| NPI Last Update Date: | 07/20/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 36-00-3017-S |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |