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General NPI Number Information
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NPI Number | 1730512906
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Entity Type | Organization
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Legal Business Name | WOMANS PHYSICIAN GROUP
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 2306 S BURNSIDE AVE SUITE B
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City | GONZALES
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State | LA
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Zip | 70737-4668
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Country | US
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Telephone | 225-450-2951
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Fax | 225-450-6354
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Provider Business Mailing Address
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Address Line | 2306 S BURNSIDE AVE SUITE B
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City | GONZALES
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State | LA
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Zip | 70737-4668
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Country | US
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Telephone | 225-450-2951
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Fax | 225-450-6354
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MRS. TERI FONTENOT
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Credential |
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Telephone | 225-924-1300
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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 |
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License Number State |
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