Healthcare Provider Details

I. General information

NPI: 1518303106
Provider Name (Legal Business Name): JENNIFER PERONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17050 MEDICAL CENTER DR
BATON ROUGE LA
70816-3221
US

IV. Provider business mailing address

17050 MEDICAL CENTER DR
BATON ROUGE LA
70816-3221
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-5200
  • Fax:
Mailing address:
  • Phone: 225-761-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10046338
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME150518
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number338603
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number338603
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: