Healthcare Provider Details

I. General information

NPI: 1255399218
Provider Name (Legal Business Name): KEITH BRYAN ISAACSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 11/20/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AUDUBON FERTILITY LLC 4321 MAGNOLIA STREET
NEW ORLEANS LA
70115
US

IV. Provider business mailing address

4321 MAGNOLIA STREET
NEW ORLEANS LA
70115
US

V. Phone/Fax

Practice location:
  • Phone: 504-891-1390
  • Fax: 504-891-1391
Mailing address:
  • Phone: 504-891-1390
  • Fax: 504-891-1391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number70563
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD.06530R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: