Provider Demographics
NPI:1720374291
Name:PAGE, JONATHAN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:PAGE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-5016
Mailing Address - Country:US
Mailing Address - Phone:504-529-5558
Mailing Address - Fax:
Practice Address - Street 1:230 OCHSNER BLVD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5246
Practice Address - Country:US
Practice Address - Phone:504-529-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD042466207Q00000X
VA0116023741207Q00000X
LALA312420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine