Healthcare Provider Details

I. General information

NPI: 1871021527
Provider Name (Legal Business Name): JONATHAN DYKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

IV. Provider business mailing address

1401 JEFFERSON HWY
NEW ORLEANS LA
70121-2426
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-1200
  • Fax: 504-842-3193
Mailing address:
  • Phone: 504-842-1200
  • Fax: 504-842-3193

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 StateLA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number331624
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: