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General NPI Number Information
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NPI Number | 1790705036
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Entity Type | Individual
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Provider Name | VICTOR E TEDESCO IV M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 04/16/2019
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Provider Practice Location Address
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Address Line | 155 HOSPITAL DR STE 201
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City | LAFAYETTE
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State | LA
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Zip | 70503-2852
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Country | US
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Telephone | 337-289-7999
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Fax | 337-289-7998
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Provider Business Mailing Address
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Address Line | 5000 AMBASSADOR CAFFERY PKWY PROVINCE BLDG. 14-A
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City | LAFAYETTE
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State | LA
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Zip | 70508-6984
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Country | US
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Telephone | 337-234-7779
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Fax | 337-235-7246
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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 |
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License Number State |
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