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General NPI Number Information
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NPI Number | 1780675736
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Entity Type | Individual
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Provider Name | JON V SCHELLACK M.D., F.A.C.S.
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 8585 PICARDY AVE 310
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City | BATON ROUGE
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State | LA
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Zip | 70809-3679
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Country | US
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Telephone | 225-767-5479
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Fax | 225-767-5147
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Provider Business Mailing Address
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Address Line | 8585 PICARDY AVE
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City | BATON ROUGE
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State | LA
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Zip | 70809-3679
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Country | US
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Telephone | 225-767-5479
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Fax | 225-767-5147
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MD.015733
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License Number State | LA
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