Healthcare Provider Details

I. General information

NPI: 1982933867
Provider Name (Legal Business Name): ELIZABETH LE,DPM,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 S RANGE AVE
DENHAM SPRINGS LA
70726-5218
US

IV. Provider business mailing address

1524 S RANGE AVE
DENHAM SPRINGS LA
70726-5218
US

V. Phone/Fax

Practice location:
  • Phone: 225-667-6497
  • Fax: 225-791-3899
Mailing address:
  • Phone: 225-667-6497
  • Fax: 225-791-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPD173R
License Number StateLA

VIII. Authorized Official

Name: ELIZABETH LE
Title or Position: OWNER
Credential: DPM
Phone: 225-667-6497