Healthcare Provider Details

I. General information

NPI: 1134565112
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF DENHAM SPRINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N RANGE AVE SUITE D
DENHAM SPRINGS LA
70726-2428
US

IV. Provider business mailing address

1211 N RANGE AVE SUITE D
DENHAM SPRINGS LA
70726-2428
US

V. Phone/Fax

Practice location:
  • Phone: 225-933-0090
  • Fax: 225-665-0055
Mailing address:
  • Phone: 225-933-0090
  • Fax: 225-665-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP07255
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number022406
License Number StateLA

VIII. Authorized Official

Name: DR. BRIAN EDWARD ZGANJAR
Title or Position: OWNER/MD
Credential: MD
Phone: 225-933-0090