Healthcare Provider Details

I. General information

NPI: 1144370941
Provider Name (Legal Business Name): JESSICA HEBERT MOULEDOUX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA ANN HEBERT M.D.

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 JEFFERSON HWY
NEW ORLEANS LA
70121-2406
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-5200
  • Fax:
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number46059
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD.202857
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: