Healthcare Provider Details

I. General information

NPI: 1518258755
Provider Name (Legal Business Name): DAVID PATRICK KENNEDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 HOUMA BLVD STE 100
METAIRIE LA
70006-2934
US

IV. Provider business mailing address

4224 HOUMA BLVD STE 100
METAIRIE LA
70006-2934
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-1000
  • Fax: 504-456-8010
Mailing address:
  • Phone: 504-454-1000
  • Fax: 504-456-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP20041200
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberP9617
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number207639
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: