1174675086 NPI number — LOUIS E DEDON D.O.

Table of content: LOUIS E DEDON D.O. (NPI 1174675086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174675086 NPI number — LOUIS E DEDON D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEDON
Provider First Name:
LOUIS
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1174675086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
229 BELLEMEADE BLVD
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
GRETNA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70056-7153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-235-3862
Provider Business Mailing Address Fax Number:
504-398-4337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 ESKEW DR
Provider Second Line Business Practice Location Address:
BUILDING 2
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71303-3763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-445-5111
Provider Business Practice Location Address Fax Number:
318-442-2261
Provider Enumeration Date:
01/18/2007

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: 2084P0800X , with the licence number:  08089R , 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: 1914860 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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