Healthcare Provider Details

I. General information

NPI: 1659313245
Provider Name (Legal Business Name): NORTH OAKS OBSTETRICS & GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15748 MEDICAL ARTS DR
HAMMOND LA
70403-1446
US

IV. Provider business mailing address

15748 MEDICAL ARTS DR
HAMMOND LA
70403-1446
US

V. Phone/Fax

Practice location:
  • Phone: 985-542-0663
  • Fax: 985-542-0698
Mailing address:
  • Phone: 985-542-0663
  • Fax: 985-542-0698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number3068871001
License Number StateLA

VIII. Authorized Official

Name: JEANNINE BUCKNER
Title or Position: CFO
Credential:
Phone: 985-542-4077