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General NPI Number Information
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NPI Number | 1508278425
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Entity Type | Organization
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Legal Business Name | PELICAN PODIATRY AND SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 05/27/2014
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Provider Practice Location Address
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Address Line | 613 WILLIAMS BLVD
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City | KENNER
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State | LA
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Zip | 70062-7635
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Country | US
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Telephone | 504-441-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 613 WILLIAMS BLVD
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City | KENNER
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State | LA
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Zip | 70062-7635
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Country | US
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Telephone | 504-441-5555
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Fax |
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Authorized Official
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Title or Position | CLINIC OWNER
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Name | MRS. MARIE PATRON
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Credential |
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Telephone | 504-441-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | DPM00327.R
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License Number State | LA
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