Healthcare Provider Details

I. General information

NPI: 1730421504
Provider Name (Legal Business Name): JAY EDWARD TRUSHEIM JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 HESPER AVE
METAIRIE LA
70005-3761
US

IV. Provider business mailing address

202 HESPER AVE
METAIRIE LA
70005-3761
US

V. Phone/Fax

Practice location:
  • Phone: 504-957-1031
  • Fax:
Mailing address:
  • Phone: 504-957-1031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.207530
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: