Provider Demographics
NPI:1508278425
Name:PELICAN PODIATRY AND SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:PELICAN PODIATRY AND SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-441-5555
Mailing Address - Street 1:613 WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-7635
Mailing Address - Country:US
Mailing Address - Phone:504-441-5555
Mailing Address - Fax:
Practice Address - Street 1:613 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-7635
Practice Address - Country:US
Practice Address - Phone:504-441-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM00327.R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty