Basic Information
| Provider Information | |||||||||
| NPI: | 1801047188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOOPER | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 JOHN STREET | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648502663 | ||||||||
| FaxNumber: | 8643060012 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 JOHN STREET | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648502663 | ||||||||
| FaxNumber: | 8643060012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2008 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 1359 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.