Healthcare Provider Details

I. General information

NPI: 1821202557
Provider Name (Legal Business Name): AMY E OCMAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 SAINT CLAIR BLVD SUITE 3015
GONZALES LA
70737-5023
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 225-743-2455
  • Fax: 225-644-5213
Mailing address:
  • Phone: 208-706-8526
  • Fax: 225-644-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number026022
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: