Healthcare Provider Details

I. General information

NPI: 1205925070
Provider Name (Legal Business Name): RONALD D. SYLVEST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7414 PICARDY STE A
BATON ROUGE LA
70808
US

IV. Provider business mailing address

7414 PICARDY STE A
BATON ROUGE LA
70808
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-6595
  • Fax: 225-769-5064
Mailing address:
  • Phone: 225-769-6595
  • Fax: 225-769-5064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD.015745
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD015745
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: