Healthcare Provider Details

I. General information

NPI: 1881821668
Provider Name (Legal Business Name): JASON RUDD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PINNACLE PKWY SUITE 3
COVINGTON LA
70433-9167
US

IV. Provider business mailing address

1200 PINNACLE PKWY SUITE 3
COVINGTON LA
70433-9167
US

V. Phone/Fax

Practice location:
  • Phone: 985-674-1700
  • Fax: 985-674-1722
Mailing address:
  • Phone: 985-674-1700
  • Fax: 985-674-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD.204827
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: