Basic Information
| Provider Information | |||||||||
| NPI: | 1124203708 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LURIE | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RUBRIGHT | ||||||||
| OtherFirstName: | JAMIE | ||||||||
| OtherMiddleName: | ANNE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3525 PRYTANIA ST | ||||||||
| Address2: | SUITE 526 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701153585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5046482510 | ||||||||
| FaxNumber: | 5048972064 | ||||||||
| Practice Location | |||||||||
| Address1: | 3525 PRYTANIA ST | ||||||||
| Address2: | SUITE 526 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701153585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5046482510 | ||||||||
| FaxNumber: | 5048972064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2008 | ||||||||
| LastUpdateDate: | 05/12/2011 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 026547 | LA | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207R00000X | 026547 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0201X | 026547 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 1061972 | 05 | LA | MEDICAID | 026547 | 01 | LA | STATE LICENSE | OTHER |