Healthcare Provider Details

I. General information

NPI: 1063516151
Provider Name (Legal Business Name): PHILIP G PADGETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N JEFFERSON AVE
PORT ALLEN LA
70767
US

IV. Provider business mailing address

8490 PICARDY AVE BLDG 200
BATON ROUGE LA
70809-3731
US

V. Phone/Fax

Practice location:
  • Phone: 225-267-6626
  • Fax: 225-267-5993
Mailing address:
  • Phone: 225-237-1754
  • Fax: 225-237-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number019597
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: