Provider Demographics
NPI:1801047188
Name:LOOPER, JASON (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LOOPER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 JOHN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640
Mailing Address - Country:US
Mailing Address - Phone:864-850-2663
Mailing Address - Fax:864-306-0012
Practice Address - Street 1:112 JOHN STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640
Practice Address - Country:US
Practice Address - Phone:864-850-2663
Practice Address - Fax:864-306-0012
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1359363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA34251223Medicare PIN
SCAA3425Medicare UPIN