Provider Demographics
NPI:1174015945
Name:SOUTHERN OBGYN LLC
Entity Type:Organization
Organization Name:SOUTHERN OBGYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGLIESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-591-0147
Mailing Address - Street 1:155 HOSPITAL DR STE 410
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 HOSPITAL DR STE 410
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2852
Practice Address - Country:US
Practice Address - Phone:337-235-4460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty