Healthcare Provider Details

I. General information

NPI: 1720070378
Provider Name (Legal Business Name): ALFREDO VICHOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 PRYTANIA ST SUITE 309
NEW ORLEANS LA
70115-3500
US

IV. Provider business mailing address

1111 MEDICAL CENTER BLVD SUITE 660 SOUTH
MARRERO LA
70072-3151
US

V. Phone/Fax

Practice location:
  • Phone: 504-897-7400
  • Fax: 504-897-7582
Mailing address:
  • Phone: 504-349-6670
  • Fax: 504-349-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number04016R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: