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General NPI Number Information
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NPI Number | 1891823829
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Entity Type | Organization
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Legal Business Name | DPMLGSPRLA LLC
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 3901 HOUMA BLVD SUITE 204
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City | METAIRIE
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State | LA
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Zip | 70006-2930
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Country | US
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Telephone | 504-888-9403
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Fax | 504-888-2895
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Provider Business Mailing Address
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Address Line | 3901 HOUMA BLVD SUITE 204
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City | METAIRIE
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State | LA
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Zip | 70006-2930
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Country | US
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Telephone | 504-888-9403
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Fax | 504-888-2895
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. LAUREN GAST
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Credential |
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Telephone | 985-635-6943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | DPM20007
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License Number State | LA
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