Provider Demographics
NPI:1003819350
Name:LILLY, JAMES DESPORTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DESPORTE
Last Name:LILLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE S-450
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3151
Mailing Address - Country:US
Mailing Address - Phone:504-349-6423
Mailing Address - Fax:504-349-6062
Practice Address - Street 1:2820 NAPOLEON AVE
Practice Address - Street 2:SUITE 720
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115
Practice Address - Country:US
Practice Address - Phone:504-896-8670
Practice Address - Fax:504-896-8699
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA24302207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1543560Medicaid
LAI06473Medicare UPIN
LA4F810Medicare PIN