Provider Demographics
NPI:1073648499
Name:NORMAN E ANSEMAN JR MD, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:NORMAN E ANSEMAN JR MD, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:ANSEMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-237-3637
Mailing Address - Street 1:PO BOX 52724
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2724
Mailing Address - Country:US
Mailing Address - Phone:337-237-3637
Mailing Address - Fax:337-237-1757
Practice Address - Street 1:1101 S COLLEGE RD STE 206
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3038
Practice Address - Country:US
Practice Address - Phone:337-237-3637
Practice Address - Fax:337-237-1757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012249208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADF6182OtherRAILROAD MEDICARE
LA1023329Medicaid
LA5CW78Medicare PIN