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General NPI Number Information
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NPI Number | 1184888638
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Entity Type | Organization
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Legal Business Name | JASPER RADIOLOGY ASSOCIATES PC
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 3560 DELAWARE ST STE 209
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City | BEAUMONT
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State | TX
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Zip | 77706-3059
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Country | US
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Telephone | 409-899-3684
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Fax |
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Provider Business Mailing Address
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Address Line | 512 MAIN ST 1401
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City | FORT WORTH
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State | TX
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Zip | 76102-3907
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. MICHAEL J. LANOUX
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Credential | MD
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Telephone | 409-899-3684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | TX
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