1154407369 NPI number — ELIZABETH LE DPM

Table of content: ELIZABETH LE DPM (NPI 1154407369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154407369 NPI number — ELIZABETH LE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LE
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

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:
1154407369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1524 SOUTH RANGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENHAM SPRINGS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-667-6497
Provider Business Mailing Address Fax Number:
225-791-3899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1524 SOUTH RANGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-667-6497
Provider Business Practice Location Address Fax Number:
225-791-3899
Provider Enumeration Date:
10/31/2006

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: 213E00000X , with the licence number:  PD173R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 231-2940 . This is a "AETNA HMO" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1685089 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 215-4406 . This is a "AETNA HMO" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: C2580 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2700152 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 212129 . This is a "COVENTRY HEALTHCARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 578-2446 . This is a "AETNA PPO" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 6981998-001 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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