Healthcare Provider Details

I. General information

NPI: 1275550071
Provider Name (Legal Business Name): TARUN JOLLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W ESPLANADE AVE SUITE B
KENNER LA
70065-2459
US

IV. Provider business mailing address

4520 WICHERS DR SUITE 205
MARRERO LA
70072-3135
US

V. Phone/Fax

Practice location:
  • Phone: 504-754-2334
  • Fax: 504-324-2078
Mailing address:
  • Phone: 504-754-2334
  • Fax: 504-324-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.025631
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number025631
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: