Provider Demographics
NPI:1114138864
Name:MILLIGAN, JASON K (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:K
Last Name:MILLIGAN
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 1:2449 HOSPITAL DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2399
Mailing Address - Country:US
Mailing Address - Phone:318-212-7839
Mailing Address - Fax:318-212-7837
Practice Address - Street 1:2449 HOSPITAL DR
Practice Address - Street 2:SUITE 420
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2399
Practice Address - Country:US
Practice Address - Phone:318-212-7839
Practice Address - Fax:318-212-7837
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1078379Medicaid
LA4M088Medicare PIN