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General NPI Number Information
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NPI Number | 1679992614
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Entity Type | Organization
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Legal Business Name | MSMD, LLC
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 2401 VETERANS MEMORIAL BLVD STE 16
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City | KENNER
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State | LA
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Zip | 70062-4730
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Country | US
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Telephone | 504-472-6130
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Fax | 504-472-6128
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Provider Business Mailing Address
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Address Line | 701 S HOWARD AVE STE 106 BOX 143
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City | TAMPA
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State | FL
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Zip | 33606-2473
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Country | US
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Telephone | 727-474-9172
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Fax | 727-474-9172
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MR. BOBBY L COATES
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Credential |
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Telephone | 813-508-1859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 014927
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License Number State | LA
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