Healthcare Provider Details

I. General information

NPI: 1841325206
Provider Name (Legal Business Name): MEDICAL ARTS ADULT AND PEDIATRIC UROLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42421 PELICAN PROFESSIONAL PARK
HAMMOND LA
70403-2405
US

IV. Provider business mailing address

42421 PELICAN PROFESSIONAL PARK
HAMMOND LA
70403-2405
US

V. Phone/Fax

Practice location:
  • Phone: 985-542-1317
  • Fax: 985-542-1958
Mailing address:
  • Phone: 985-542-1317
  • Fax: 985-542-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BONADELVERT C. SUAREZ
Title or Position: OWNER
Credential: M.D.
Phone: 985-542-1317