Healthcare Provider Details

I. General information

NPI: 1417983271
Provider Name (Legal Business Name): BABU JASTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 MAIN ST STE. 1000
ZACHARY LA
70791-4092
US

IV. Provider business mailing address

PO BOX 4176
HOUMA LA
70361-4176
US

V. Phone/Fax

Practice location:
  • Phone: 225-654-1559
  • Fax: 225-654-6212
Mailing address:
  • Phone: 985-872-5864
  • Fax: 985-872-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD429922
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberPENDING
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD429922
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number304196
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: