Provider Demographics
NPI:1003129651
Name:BRIDGES, JASON PEARY
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:PEARY
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD STE 608
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4366
Mailing Address - Country:US
Mailing Address - Phone:225-767-0394
Mailing Address - Fax:225-767-3904
Practice Address - Street 1:7777 HENNESSY BLVD STE 608
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4366
Practice Address - Country:US
Practice Address - Phone:225-767-0394
Practice Address - Fax:225-767-3904
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.208016208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA429019Medicare UPIN