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NPI Code Detail

MEDICARE: ANTHONY LESLIE VANDUZEE PAC

MEDICARE: ANTHONY LESLIE VANDUZEE PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantA10412LA
2363AS0400XSurgical Physician AssistantA10412LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184701930
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY LESLIE VANDUZEE PAC
Provider Business Mailing Address
First Line : 5439 AIRLINE HWY
Second Line :
City : BATON ROUGE
State : LA
Zip : 70805-1712
Country : US
Telephone Number : 225-358-2280
Fax Number :
Provider Business Practice Location Address
First Line : 5439 AIRLINE HWY
Second Line :
City : BATON ROUGE
State : LA
Zip : 70805-1712
Country : US
Telephone Number : 225-358-2280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 04/17/2024

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Directions to “ ANTHONY LESLIE VANDUZEE PAC” Practice Location

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