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General NPI Number Information
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NPI Number | 1952778789
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Entity Type | Individual
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Provider Name | JASON BRET LARGUE PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 6801 AIRPORT BLVD
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City | MOBILE
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State | AL
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Zip | 36608-3709
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Country | US
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Telephone | 251-266-3580
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Fax | 251-266-3851
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Provider Business Mailing Address
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Address Line | PO BOX 36258
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City | BELFAST
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State | ME
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Zip | 04915-1204
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Country | US
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Telephone | 251-318-2678
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Fax | 251-405-9900
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.1073
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License Number State | AL
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