Provider Demographics
NPI:1093914095
Name:PEDRO A SERRANT MD LLC
Entity Type:Organization
Organization Name:PEDRO A SERRANT MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:A
Authorized Official - Last Name:SERRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-646-4464
Mailing Address - Street 1:1850 GAUSE BLVD E
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5442
Mailing Address - Country:US
Mailing Address - Phone:985-646-4464
Mailing Address - Fax:985-646-4475
Practice Address - Street 1:1850 GAUSE BLVD E
Practice Address - Street 2:SUITE 103
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5442
Practice Address - Country:US
Practice Address - Phone:985-646-4464
Practice Address - Fax:985-646-4475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08708R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAA96634Medicare UPIN