=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164926911
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC STOCKWELL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2018
-----------------------------------------------------
Last Update Date | 08/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3001 22ND ST
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70002-4918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-949-0450
-----------------------------------------------------
Fax | 504-290-1146
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3001 22ND ST
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70002-4918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-949-0450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 321118
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------