Healthcare Provider Details

I. General information

NPI: 1649596107
Provider Name (Legal Business Name): ANDREW ELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 ESSEN LN
BATON ROUGE LA
70809-3738
US

IV. Provider business mailing address

4950 ESSEN LN
BATON ROUGE LA
70809-3738
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-0847
  • Fax: 225-766-0218
Mailing address:
  • Phone: 225-767-0847
  • Fax: 225-766-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number208135
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: