Healthcare Provider Details

I. General information

NPI: 1326590530
Provider Name (Legal Business Name): SURGICAL CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 17TH ST
METAIRIE LA
70002-3518
US

IV. Provider business mailing address

2615 GAULT AVE N
FORT PAYNE AL
35967-3728
US

V. Phone/Fax

Practice location:
  • Phone: 256-997-0196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD08891R
License Number StateLA

VIII. Authorized Official

Name: ROBERT RAYMOND
Title or Position: PRESIDENT
Credential: MD
Phone: 256-997-0196