Basic Information
| Provider Information | |||||||||
| NPI: | 1821197740 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JASMAN | ||||||||
| FirstName: | LORA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3649 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992203649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098382531 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20 EAST J. STREET | ||||||||
| Address2: | |||||||||
| City: | DEER PARK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098382531 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 16205 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | M-9488 | ID | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD00045143 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 136364 | 01 | OR | OMAP, OREGON HEALTH PLAN | OTHER | 8493678 | 05 | WA | MEDICAID |