Healthcare Provider Details

I. General information

NPI: 1295919991
Provider Name (Legal Business Name): CAROLA B. OKOGBAA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 HOWELL BLVD SUITE 130A
BATON ROUGE LA
70807-5256
US

IV. Provider business mailing address

7855 HOWELL BLVD SUITE 130A
BATON ROUGE LA
70807-5256
US

V. Phone/Fax

Practice location:
  • Phone: 225-356-2655
  • Fax: 225-356-2358
Mailing address:
  • Phone: 225-356-2655
  • Fax: 225-356-2358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD.201426
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: