Healthcare Provider Details

I. General information

NPI: 1366417248
Provider Name (Legal Business Name): OCCUPATIONAL MEDICINE CENTER OF WEST JEFFERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 WESTBANK EXPY
MARRERO LA
70072-3102
US

IV. Provider business mailing address

4475 WESTBANK EXPY
MARRERO LA
70072-3102
US

V. Phone/Fax

Practice location:
  • Phone: 504-347-8471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD WEI
Title or Position: OWNER/ MD
Credential:
Phone: 504-347-8471