Provider Demographics
NPI:1740219583
Name:ELISON, JASMINE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:R
Last Name:ELISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4224 HOUMA BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2933
Mailing Address - Country:US
Mailing Address - Phone:504-456-2691
Mailing Address - Fax:504-456-2692
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2933
Practice Address - Country:US
Practice Address - Phone:504-456-2691
Practice Address - Fax:504-456-2692
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA201726207WX0107X, 207WX0107X
CT044498207W00000X
NY225682-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1020206Medicaid
LA4K865Medicare PIN
LA1020206Medicaid