Provider Demographics
NPI:1114135829
Name:LANDRY, JASON D (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:LANDRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:121 RUE LOUIS XIV
Mailing Address - Street 2:BUILDING 9, SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-988-9737
Mailing Address - Fax:337-988-9739
Practice Address - Street 1:121 RUE LOUIS XIV
Practice Address - Street 2:BUILDING 9, SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-988-9737
Practice Address - Fax:337-988-9739
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA201261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1238376Medicaid
LAP00808639OtherRR MEDICARE
LA1238376Medicaid