Provider Demographics
NPI:1003005885
Name:JASTER, JAMES H (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:JASTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SOUTH PAULINE STREET,
Mailing Address - Street 2:SUITE 709
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3121
Mailing Address - Country:US
Mailing Address - Phone:901-577-9467
Mailing Address - Fax:901-362-6618
Practice Address - Street 1:23 SOUTH PAULINE STREET,
Practice Address - Street 2:SUITE 709
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3121
Practice Address - Country:US
Practice Address - Phone:901-577-9467
Practice Address - Fax:901-362-6618
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD-263762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1811816Medicaid
TN3032118OtherBLUE CROSS BLUE SHIELD
TN4173667OtherBLUECROSS BLUESHIELD
TN1510855Medicaid
TN3098864Medicare PIN
TN3032118OtherBLUE CROSS BLUE SHIELD
TN1811816Medicaid