Provider Demographics
NPI:1629343959
Name:BORDELON, ASHLEY DOUCET (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DOUCET
Last Name:BORDELON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4373
Mailing Address - Country:US
Mailing Address - Phone:225-246-9790
Mailing Address - Fax:225-246-9100
Practice Address - Street 1:230 ROBERTS DR
Practice Address - Street 2:SUITE I
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-2661
Practice Address - Country:US
Practice Address - Phone:225-638-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA206276OtherSTATE LICENSES
LA2199056Medicaid