Provider Demographics
NPI:1093994287
Name:ABAUNZA, ALFRED EUGENE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:EUGENE
Last Name:ABAUNZA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LAKE MARINA DR
Mailing Address - Street 2:# 11BW
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1676
Mailing Address - Country:US
Mailing Address - Phone:504-421-8220
Mailing Address - Fax:
Practice Address - Street 1:300 LAKE MARINA DR
Practice Address - Street 2:# 11BW
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-1676
Practice Address - Country:US
Practice Address - Phone:504-421-8220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine