Provider Demographics
NPI:1699872721
Name:JASE, ANTHONY S (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:S
Last Name:JASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:STEPHEN
Other - Last Name:JASE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 19644
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70179-0644
Mailing Address - Country:US
Mailing Address - Phone:504-264-2116
Mailing Address - Fax:504-617-6108
Practice Address - Street 1:11000 N HARDY ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2838
Practice Address - Country:US
Practice Address - Phone:504-264-2116
Practice Address - Fax:504-617-6108
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025492207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1575691Medicaid
LA4F590Medicare ID - Type Unspecified
LA1575691Medicaid