Healthcare Provider Details

I. General information

NPI: 1750367165
Provider Name (Legal Business Name): STEPHEN SESSUMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 BLUEBONNET BLVD SUITE 2020
BATON ROUGE LA
70810-7827
US

IV. Provider business mailing address

8080 BLUEBONNET BLVD SUITE 2020
BATON ROUGE LA
70810-7827
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-2099
  • Fax:
Mailing address:
  • Phone: 225-767-2099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number017188LA
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: