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General NPI Number Information
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NPI Number | 1104879253
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Entity Type | Individual
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Provider Name | THEODORE A. IRRA MD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 3434 HOUMA BLVD SUITE 200
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City | METAIRIE
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State | LA
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Zip | 70006-4200
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Country | US
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Telephone | 504-458-6061
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Fax | 504-866-0206
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Provider Business Mailing Address
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Address Line | 3434 HOUMA BLVD STE 200
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City | METAIRIE
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State | LA
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Zip | 70006-4278
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Country | US
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Telephone | 504-458-6061
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Fax | 504-866-0206
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 11701R
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD.08928R
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD.08928R
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License Number State | LA
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