Facts
- Status
- A
- Credential
- M.D.
- Type
- Individual
- Enumeration date
- 2016-03-23
- Last updated
- 2021-03-02
Licenses
- License MS
- 25251
- License MS
- 25251
- License MS
- 25251
- License LA
- 325147
Location
- Practice location
- 2750 GAUSE BLVD E
- City
- SLIDELL LA
- Postal code
- 704614149
- Phone
- 985-639-3777
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.