Healthcare Provider Details

I. General information

NPI: 1730188806
Provider Name (Legal Business Name): RUFUS LESTER HIXON III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 CONSTANTIN BLVD STE 200
BATON ROUGE LA
70809-3481
US

IV. Provider business mailing address

8200 CONSTANTIN BLVD STE 200
BATON ROUGE LA
70809-3481
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-6700
  • Fax: 225-767-6721
Mailing address:
  • Phone: 225-767-6700
  • Fax: 225-767-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12087R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number12087R
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD.12087R
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number12087R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: