Provider Demographics
NPI:1316814460
Name:BURDEAUX, JASON LOUIS (EMT-P)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LOUIS
Last Name:BURDEAUX
Suffix:
Gender:M
Credentials:EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 ORTIZ AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-7812
Mailing Address - Country:US
Mailing Address - Phone:239-533-3911
Mailing Address - Fax:239-485-2626
Practice Address - Street 1:2675 ORTIZ AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7812
Practice Address - Country:US
Practice Address - Phone:239-533-3911
Practice Address - Fax:239-485-2626
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMD540096207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty