Healthcare Provider Details

I. General information

NPI: 1295984961
Provider Name (Legal Business Name): JENNIFER MARIE MALSBURY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 RUE DE SANTE STE 105 RIVER REGION SURGICAL SPECIALISTS
LA PLACE LA
70068-5424
US

IV. Provider business mailing address

1514 JEFFERSON HWY RIVER REGION SURGICAL SPECIALISTS
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 985-653-1605
  • Fax: 985-653-1609
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDO.000248
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: