Healthcare Provider Details

I. General information

NPI: 1205006111
Provider Name (Legal Business Name): MELISSA HAGGERTY ROY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 103
BATON ROUGE LA
70808-4363
US

IV. Provider business mailing address

7777 HENNESSY BLVD STE 103
BATON ROUGE LA
70808-4363
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 Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number201689
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number201689
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: