Healthcare Provider Details

I. General information

NPI: 1013286244
Provider Name (Legal Business Name): JASON ANTHONY CORDES CO,BOCOP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PERDIDO ST
NEW ORLEANS LA
70112-1262
US

IV. Provider business mailing address

PO BOX 61011
NEW ORLEANS LA
70161-1011
US

V. Phone/Fax

Practice location:
  • Phone: 504-553-5835
  • Fax: 504-553-5832
Mailing address:
  • Phone: 504-553-5835
  • Fax: 504-553-5832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCO003405
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: