Provider Demographics
NPI:1003128463
Name:PERDOMO, JOEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:E
Last Name:PERDOMO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2104 GAUSE BLVD W
Mailing Address - Street 2:SUITEA
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-4130
Mailing Address - Country:US
Mailing Address - Phone:985-643-4575
Mailing Address - Fax:985-643-4513
Practice Address - Street 1:2104 GAUSE BLVD W
Practice Address - Street 2:SUITEA
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-4130
Practice Address - Country:US
Practice Address - Phone:985-643-4575
Practice Address - Fax:985-643-4513
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2023-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA207966208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice