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General NPI Number Information
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NPI Number | 1235428616
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Entity Type | Organization
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Legal Business Name | EDWARD MADISON III, L.L.C
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 9511 CHEF MENTEUR SUITE 114
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City | NEW ORLEANS
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State | LA
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Zip | 70127-4231
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Country | US
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Telephone | 504-241-0861
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Fax | 504-241-0850
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Provider Business Mailing Address
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Address Line | 9511 CHEF MENTEUR SUITE 114
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City | NEW ORLEANS
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State | LA
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Zip | 70127-4231
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Country | US
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Telephone | 504-241-0861
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Fax | 504-241-0850
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. EDWARD MADISON III
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Credential | M.D.
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Telephone | 504-241-0861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 020631
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License Number State | LA
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