Healthcare Provider Details

I. General information

NPI: 1861440331
Provider Name (Legal Business Name): LIONEL H HEAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 GARDEN RD
RIVER RIDGE LA
70123-2003
US

IV. Provider business mailing address

309 GARDEN RD
RIVER RIDGE LA
70123-2003
US

V. Phone/Fax

Practice location:
  • Phone: 504-737-8243
  • Fax:
Mailing address:
  • Phone: 504-737-8243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD.008984
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: