Healthcare Provider Details

I. General information

NPI: 1518233352
Provider Name (Legal Business Name): MARK ANDREW PRICE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 HOUMA BLVD STE 300
METAIRIE LA
70006-4203
US

IV. Provider business mailing address

340 BONNABEL BLVD APT A
METAIRIE LA
70005-3769
US

V. Phone/Fax

Practice location:
  • Phone: 504-264-5142
  • Fax:
Mailing address:
  • Phone: 801-875-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number305282
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: