Healthcare Provider Details

I. General information

NPI: 1417488826
Provider Name (Legal Business Name): RYAN LEE BASQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 503
BATON ROUGE LA
70808-4366
US

IV. Provider business mailing address

1430 TULANE AVE
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-2273
  • Fax: 225-374-0251
Mailing address:
  • Phone: 504-988-9963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number323211
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number323211
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number323211
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: