Provider Demographics
NPI:1649563008
Name:GULF SOUTH FOOT & ANKLE, LLC
Entity Type:Organization
Organization Name:GULF SOUTH FOOT & ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:T
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:504-454-3004
Mailing Address - Street 1:2520 HARVARD AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1118
Mailing Address - Country:US
Mailing Address - Phone:504-454-3004
Mailing Address - Fax:504-454-3075
Practice Address - Street 1:2520 HARVARD AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1118
Practice Address - Country:US
Practice Address - Phone:504-454-3004
Practice Address - Fax:504-454-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DV04Medicare PIN
LA6662640001Medicare NSC