Healthcare Provider Details

I. General information

NPI: 1760792931
Provider Name (Legal Business Name): IEDM SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8733 SIEGEN LN STE 369
BATON ROUGE LA
70810-1945
US

IV. Provider business mailing address

8733 SIEGEN LN STE 369
BATON ROUGE LA
70810-1945
US

V. Phone/Fax

Practice location:
  • Phone: 504-335-8010
  • Fax:
Mailing address:
  • Phone: 504-335-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number022322
License Number StateLA

VIII. Authorized Official

Name: EDAN MORAN
Title or Position: CEO
Credential:
Phone: 504-335-8010