Healthcare Provider Details

I. General information

NPI: 1518228212
Provider Name (Legal Business Name): CODY ROI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 TULANE AVE DEPT OF
NEW ORLEANS LA
70112-2865
US

IV. Provider business mailing address

1542 TULANE AVE DEPT OF PSYCHIATRY 2ND FLOOR
NEW ORLEANS LA
70112-2865
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-6004
  • Fax:
Mailing address:
  • Phone: 504-568-6004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberDO.000430
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: