=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700768751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METAIRIE PRIMARY CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2025
-----------------------------------------------------
Last Update Date | 07/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3901 HOUMA BLVD STE 501B
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70006-2930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-782-8267
-----------------------------------------------------
Fax | 504-779-3508
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3901 HOUMA BLVD STE 501B
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70006-2930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-782-8267
-----------------------------------------------------
Fax | 504-779-3508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MARIE T PATRON
-----------------------------------------------------
Credential | OWNER
-----------------------------------------------------
Telephone | 504-782-8267
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------