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NPI Code Detail

MEDICARE: DR. JUDITH CANELLA BLAISE M.D.

MEDICARE: DR. JUDITH CANELLA BLAISE M.D.
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
1207V00000XObstetrics & Gynecology Physician020707LA
2207VX0000XObstetrics PhysicianMD.020707LA

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 : 1275578130
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUDITH CANELLA BLAISE M.D.
Provider Business Mailing Address
First Line : PO BOX 5237
Second Line :
City : THIBODAUX
State : LA
Zip : 70302-5237
Country : US
Telephone Number : 985-803-0584
Fax Number : 985-449-0700
Provider Business Practice Location Address
First Line : 602 N ACADIA RD
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-4823
Country : US
Telephone Number : 985-493-4706
Fax Number : 985-449-2595
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2006
Last Update Date : 01/09/2019

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