Provider Demographics
NPI:1598856155
Name:ROLLING, JASON L
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:L
Last Name:ROLLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19343 SUNSHINE AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8834
Mailing Address - Country:US
Mailing Address - Phone:985-892-5117
Mailing Address - Fax:985-892-5128
Practice Address - Street 1:19343 SUNSHINE AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8834
Practice Address - Country:US
Practice Address - Phone:985-892-5117
Practice Address - Fax:985-892-5128
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025817207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1025836Medicaid
LA4K889Medicare PIN
LAI63888Medicare UPIN
LA1025836Medicaid