Healthcare Provider Details

I. General information

NPI: 1609102045
Provider Name (Legal Business Name): NEUROSURGERY ASSOCIATES OF LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 HOWELL BLVD SUITE 130-B
BATON ROUGE LA
70807-2016
US

IV. Provider business mailing address

7855 HOWELL BLVD SUITE 130-B
BATON ROUGE LA
70807-2016
US

V. Phone/Fax

Practice location:
  • Phone: 225-276-0536
  • Fax:
Mailing address:
  • Phone: 225-276-0536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number200648
License Number StateLA

VIII. Authorized Official

Name: GARY C DENNIS
Title or Position: OWNER/ADMINISTRATOR
Credential: MD
Phone: 225-276-0536