Basic Information
| Provider Information | |||||||||
| NPI: | 1720374291 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAGE | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1936 MAGAZINE ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701305016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045295558 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 230 OCHSNER BLVD | ||||||||
| Address2: | |||||||||
| City: | GRETNA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700565246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045295558 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2011 | ||||||||
| LastUpdateDate: | 11/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD042466 | DC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0116023741 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | LA312420 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.