Healthcare Provider Details

I. General information

NPI: 1780637223
Provider Name (Legal Business Name): LOUISIANA INSTITUTE OF PHYSICAL MEDICINE & FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8338 SUMMA AVE STE 500
BATON ROUGE LA
70809-3669
US

IV. Provider business mailing address

PO BOX 84330
BATON ROUGE LA
70884
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-1616
  • Fax: 225-766-2645
Mailing address:
  • Phone: 225-766-1616
  • Fax: 225-766-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number08510R
License Number StateLA

VIII. Authorized Official

Name: GREGORY WARD
Title or Position: PROVIDER
Credential: M.D.
Phone: 225-766-1616