Healthcare Provider Details

I. General information

NPI: 1235464546
Provider Name (Legal Business Name): CRESCENT CITY SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7311 DOWNMAN RD
NEW ORLEANS LA
70126-1213
US

IV. Provider business mailing address

7311 DOWNMAN RD
NEW ORLEANS LA
70126-1213
US

V. Phone/Fax

Practice location:
  • Phone: 504-265-0089
  • Fax: 504-241-1945
Mailing address:
  • Phone: 504-265-0089
  • Fax: 504-241-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DENARDO DOLPHIN DUNHAM
Title or Position: OWNER
Credential: DPM, MBA
Phone: 504-265-0089