Healthcare Provider Details

I. General information

NPI: 1386083178
Provider Name (Legal Business Name): WOMAN'S GYNECOLOGIC ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST SUITE 311
BATON ROUGE LA
70817-5127
US

IV. Provider business mailing address

500 RUE DE LA VIE ST SUITE 311
BATON ROUGE LA
70817-5127
US

V. Phone/Fax

Practice location:
  • Phone: 225-216-3006
  • Fax: 225-216-1081
Mailing address:
  • Phone: 225-216-3006
  • Fax: 225-216-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS BAGGETT
Title or Position: DIRECTOR
Credential:
Phone: 225-924-8310