Basic Information
Provider Information
NPI: 1003005885
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JASTER
FirstName: JAMES
MiddleName: H
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XMD-26376TNY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

ID Information
IDTypeStateIssuerDescription
417366701TNBLUECROSS BLUESHIELDOTHER
303211801TNBLUE CROSS BLUE SHIELDOTHER
151085505TN MEDICAID
181181605TN MEDICAID


Home