Healthcare Provider Details

I. General information

NPI: 1639226434
Provider Name (Legal Business Name): BRIDGET ANNE ORY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIDGET ORY DICKERSON MD

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 S TYLER ST
COVINGTON LA
70433-2330
US

IV. Provider business mailing address

85 WHISPERWOOD BLVD
SLIDELL LA
70458-1136
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-6088
  • Fax:
Mailing address:
  • Phone: 985-781-8565
  • Fax: 985-781-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42068
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number203873
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: