Provider Demographics
NPI:1114154911
Name:THURSTON, JARED S (MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:S
Last Name:THURSTON
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 1:1018 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1914
Mailing Address - Country:US
Mailing Address - Phone:985-380-5688
Mailing Address - Fax:
Practice Address - Street 1:1018 8TH ST
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1914
Practice Address - Country:US
Practice Address - Phone:985-380-5688
Practice Address - Fax:985-329-2661
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD203920207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1956821Medicaid
LA326086YWZMMedicare PIN