Basic Information
Provider Information
NPI: 1831357375
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOSEPH
FirstName: JAMIE
MiddleName: PERRY
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 54287
Address2:  
City: NEW ORLEANS
State: LA
PostalCode: 701544287
CountryCode: US
TelephoneNumber: 3377061605
FaxNumber: 3379930547
Practice Location
Address1: 1448 S COLLEGE RD
Address2:  
City: LAFAYETTE
State: LA
PostalCode: 705032920
CountryCode: US
TelephoneNumber: 3375711300
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/31/2008
LastUpdateDate: 07/21/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XMD206950LAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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