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General NPI Number Information
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NPI Number | 1477700656
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Entity Type | Organization
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Legal Business Name | IBERIA BONE JOINT & FOOT CLINIC AMC
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 7855 HOWELL BLVD STE 200
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City | BATON ROUGE
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State | LA
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Zip | 70807-5257
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Country | US
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Telephone | 225-454-6000
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Fax | 225-302-7255
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Provider Business Mailing Address
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Address Line | 7855 HOWELL BLVD STE 200
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City | BATON ROUGE
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State | LA
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Zip | 70807-5257
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Country | US
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Telephone | 225-454-6000
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Fax | 225-302-7255
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Authorized Official
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Title or Position | MD
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Name | THEODORE KNATT
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Credential | M.D.
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Telephone | 225-454-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 021167
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License Number State | LA
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