Provider Demographics
NPI:1639174881
Name:BARRILLEAUX, CHRISTOPHER NISSEN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:NISSEN
Last Name:BARRILLEAUX
Suffix:
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 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:STE 210
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2489
Practice Address - Country:US
Practice Address - Phone:504-842-8546
Practice Address - Fax:504-464-8586
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015759207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1399868Medicaid
MS00014034Medicaid
MS00014034Medicaid
LA1399868Medicaid
LA5N031Medicare PIN
LA449742YH3UMedicare PIN