Provider Demographics
NPI:1225085525
Name:EAST JEFFERSON FAMILY PRACTICE L.L.C.
Entity Type:Organization
Organization Name:EAST JEFFERSON FAMILY PRACTICE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-885-2505
Mailing Address - Street 1:PO BOX 54576
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4576
Mailing Address - Country:US
Mailing Address - Phone:504-885-2505
Mailing Address - Fax:504-885-2510
Practice Address - Street 1:3848 VETERANS BLVD.
Practice Address - Street 2:SUITE 101
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-885-2505
Practice Address - Fax:504-885-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1123897Medicaid
LA4E230Medicare PIN
LA7046160001Medicare NSC