Basic Information
| Provider Information | |||||||||
| NPI: | 1003005885 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JASTER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 SOUTH PAULINE STREET, | ||||||||
| Address2: | SUITE 709 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381043121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015779467 | ||||||||
| FaxNumber: | 9013626618 | ||||||||
| Practice Location | |||||||||
| Address1: | 23 SOUTH PAULINE STREET, | ||||||||
| Address2: | SUITE 709 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381043121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015779467 | ||||||||
| FaxNumber: | 9013626618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2007 | ||||||||
| LastUpdateDate: | 01/04/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | MD-26376 | TN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 1811816 | 05 | TN | MEDICAID | 3032118 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 4173667 | 01 | TN | BLUECROSS BLUESHIELD | OTHER | 1510855 | 05 | TN | MEDICAID |