Basic Information
| Provider Information | |||||||||
| NPI: | 1245267244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALLS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 806 JEFFERSON TER | ||||||||
| Address2: | |||||||||
| City: | NEW IBERIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705605727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373654945 | ||||||||
| FaxNumber: | 3373766860 | ||||||||
| Practice Location | |||||||||
| Address1: | 317 DERNIER ST | ||||||||
| Address2: | |||||||||
| City: | SAINT MARTINVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373422566 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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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 | 207Q00000X | MD.205006 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2181831 | 05 | LA | MEDICAID |