Individual
JASON LEE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 BELLE CHASSE HWY, TERRYTOWN, LA 70056-7127
(504) 391-5157
Mailing address
2500 BELLE CHASSE HWY, TERRYTOWN, LA 70056-7127
(504) 391-5157
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
A112590
CA
207L00000X
Anesthesiology Physician
Primary
MD.202012
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02470860
—
MS
05
—
1000922
—
LA
Enumeration date
08/01/2007
Last updated
08/10/2012
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