Provider Demographics
NPI:1518761857
Name:PRISO, JEAN PIERRE (RT(R))
Entity type:Individual
Prefix:MR
First Name:JEAN PIERRE
Middle Name:
Last Name:PRISO
Suffix:
Gender:
Credentials:RT(R)
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10849 MEADOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3513
Mailing Address - Country:US
Mailing Address - Phone:317-797-1133
Mailing Address - Fax:
Practice Address - Street 1:3905 VINCENNES RD STE 303
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3030
Practice Address - Country:US
Practice Address - Phone:317-827-5058
Practice Address - Fax:317-471-3508
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INXT0218112471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography