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General NPI Number Information
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NPI Number | 1144896051
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Entity Type | Individual
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Provider Name | JASON LAUDERDALE DO
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Gender | Male
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 07/28/2024
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Provider Practice Location Address
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Address Line | 301 UNIVERSITY BLVD
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City | GALVESTON
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State | TX
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Zip | 77555-3503
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Country | US
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Telephone | 409-772-0642
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Fax | 409-747-0777
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Provider Business Mailing Address
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Address Line | 301 UNIVERSITY BLVD
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City | GALVESTON
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State | TX
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Zip | 77555-0435
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Country | US
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Telephone | 409-772-0644
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Fax | 409-747-0777
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | BP10089921
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | MO
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