Provider Demographics
NPI:1487143392
Name:LAPORTE, JASON (DPM)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LAPORTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 CHARLOTTE AVE STE F185
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4066
Mailing Address - Country:US
Mailing Address - Phone:615-612-0122
Mailing Address - Fax:
Practice Address - Street 1:1505 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2500
Practice Address - Country:US
Practice Address - Phone:706-259-6882
Practice Address - Fax:706-259-3786
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1080213ES0103X
GAPOD305025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery