Healthcare Provider Details

I. General information

NPI: 1508131830
Provider Name (Legal Business Name): DANIELLE EGGIE THOMPSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST STE 405
BATON ROUGE LA
70817-5128
US

IV. Provider business mailing address

PO BOX 45171
BATON ROUGE LA
70895-4171
US

V. Phone/Fax

Practice location:
  • Phone: 225-928-2555
  • Fax: 225-929-9685
Mailing address:
  • Phone: 225-928-2555
  • Fax: 225-929-9685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD.207710
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: