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Physicians Psychiatry & Neurology Addiction Medicine

Provider NPI: 1679501712

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 504-464-1021  Fax: 504-464-1022

Business Mailing Address:
PO BOX 641268  KENNER, LA 70064-1268 US
Tel: 504-464-1021  Fax: 504-464-1022

NPI Information:
NPI: 1679501712
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Psychiatry & Neurology
Addiction Medicine
Psychiatry & Neurology
Psychiatry & Neurology
Psychiatry & Neurology
Psychiatry & Neurology

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 2084P0800X





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