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NPI Code Detail

MEDICARE: DR. JASON G VILLAVASSO

MEDICARE: DR. JASON G VILLAVASSO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist017972LA

General Provider Information

NPI Number : 1568744928
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON G VILLAVASSO
Provider Business Mailing Address
First Line : 3550 GOVERNMENT ST
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-5718
Country : US
Telephone Number : 225-343-8878
Fax Number :
Provider Business Practice Location Address
First Line : 3550 GOVERNMENT ST
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-5718
Country : US
Telephone Number : 225-343-8878
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2011
Last Update Date : 09/12/2011

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