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General NPI Number Information
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NPI Number | 1881860088
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Entity Type | Organization
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Legal Business Name | CROSS GATES PEDIATRICS, INC
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 3020 GAUSE BLVD E
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City | SLIDELL
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State | LA
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Zip | 70461-4155
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Country | US
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Telephone | 985-726-0800
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Fax | 985-726-0803
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Provider Business Mailing Address
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Address Line | 3020 GAUSE BLVD E
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City | SLIDELL
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State | LA
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Zip | 70461-4155
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Country | US
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Telephone | 985-726-0800
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Fax | 985-726-0803
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANGELA SMITH DUTHU
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Credential | MD
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Telephone | 985-726-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD.015652
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License Number State | LA
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