MEDICARE: DR. ELLIE FOX WETSMAN MD

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
1	208000000X	Pediatrics Physician	11725R	LA
2	2080C0008X	Child Abuse Pediatrics Physician	11725R	LA

Other Identifiers

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

General Provider Information

NPI Number	:	1285836858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIE FOX WETSMAN MD

Provider Business Mailing Address
First Line	:	200 HENRY CLAY AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70118-5720
Country	:	US
Telephone Number	:	504-896-9236
Fax Number	:	504-894-8744

Provider Business Practice Location Address
First Line	:	200 HENRY CLAY AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70118-5720
Country	:	US
Telephone Number	:	504-896-9236
Fax Number	:	504-894-8744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	01/28/2014

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