Healthcare Provider Details

I. General information

NPI: 1316105182
Provider Name (Legal Business Name): TROY ALLAN BEAUCOUDRAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 DIVISION ST
METAIRIE LA
70002-4611
US

IV. Provider business mailing address

3409 DIVISION ST.
METAIRIE LA
70002
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-7246
  • Fax: 504-454-3299
Mailing address:
  • Phone: 504-454-7246
  • Fax: 504-454-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD 201074
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberMD 201074
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: