Provider Demographics
NPI:1336282193
Name:HARREL, JASON CARR (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CARR
Last Name:HARREL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9441 LBJ FWY STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4500
Mailing Address - Country:US
Mailing Address - Phone:972-664-6963
Mailing Address - Fax:770-237-4731
Practice Address - Street 1:2600 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3908
Practice Address - Country:US
Practice Address - Phone:972-664-6963
Practice Address - Fax:770-237-4731
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2008-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA200050207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1060259Medicaid
LAI41891Medicare UPIN
LA1060259Medicaid