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General NPI Number Information
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NPI Number | 1194870782
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE MEDICAL ASSOCIATES OF NEW ORLEANS, LLC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 4001 GEN DEGAULLE DR SUITE H
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City | NEW ORLEANS
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State | LA
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Zip | 70114-8220
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Country | US
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Telephone | 504-365-9906
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Fax | 504-365-9902
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Provider Business Mailing Address
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Address Line | 4001 GEN DEGAULLE DR SUITE H
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City | NEW ORLEANS
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State | LA
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Zip | 70114-8220
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Country | US
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Telephone | 504-365-9906
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Fax | 504-365-9902
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. BERTRAND TILLERY JR.
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Credential | MD
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Telephone | 504-365-9906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 025561
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License Number State | LA
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