Provider Demographics
NPI:1568733814
Name:JASON D LANDRY MD LLC
Entity Type:Organization
Organization Name:JASON D LANDRY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-365-1500
Mailing Address - Street 1:2312 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4064
Mailing Address - Country:US
Mailing Address - Phone:337-365-1500
Mailing Address - Fax:337-365-1530
Practice Address - Street 1:2312 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4064
Practice Address - Country:US
Practice Address - Phone:337-365-1500
Practice Address - Fax:337-365-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty