Healthcare Provider Details

I. General information

NPI: 1831107309
Provider Name (Legal Business Name): JOHNNY BILL DELASHAW JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE # 8047
NEW ORLEANS LA
70112-2632
US

IV. Provider business mailing address

1430 TULANE AVE # 8047
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5565
  • Fax:
Mailing address:
  • Phone: 504-988-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD00023061
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD17696
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number325661
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: