Healthcare Provider Details

I. General information

NPI: 1174522122
Provider Name (Legal Business Name): BONE & JOINT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 WICHERS DR
MARRERO LA
70072-3002
US

IV. Provider business mailing address

2600 BELLE CHASSE HWY SUITE I
TERRYTOWN LA
70056-7156
US

V. Phone/Fax

Practice location:
  • Phone: 504-347-5421
  • Fax: 504-378-9331
Mailing address:
  • Phone: 504-391-7670
  • Fax: 504-378-9439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL J GALLAGHER
Title or Position: SECRETARY
Credential: MD
Phone: 504-347-5421