Provider Demographics
NPI:1417983271
Name:JASTI, BABU (MD)
Entity Type:Individual
Prefix:DR
First Name:BABU
Middle Name:
Last Name:JASTI
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:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-872-5864
Mailing Address - Fax:985-872-0617
Practice Address - Street 1:6550 MAIN ST
Practice Address - Street 2:STE. 1000
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4092
Practice Address - Country:US
Practice Address - Phone:225-654-1559
Practice Address - Fax:225-654-6212
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPENDING207RI0011X
PAMD429922207RC0000X, 207RI0011X
LA304196207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101730640Medicaid
LA2434616Medicaid
NJ0113638Medicaid
LA2434616Medicaid
LA556484YJQDMedicare PIN