1932188174 NPI number — JASON LEMARR HENRY M.D.

Table of content: (NPI 1407862006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932188174 NPI number — JASON LEMARR HENRY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRY
Provider First Name:
JASON
Provider Middle Name:
LEMARR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932188174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
366 MIZZEN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32507-8681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-271-3494
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 HOVEY RD
Provider Second Line Business Practice Location Address:
NAVAL AEROSPACE MEDICINE INSTITUTE
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32508-1044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-452-9484
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083A0100X , with the licence number:  0101238546 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: ME157587 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: QD405 . This is a "MEDICARE PTAN OHRI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 114629300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84NCY . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: QD404 . This is a "MEDICARE PTAN OHMG" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 114629300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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