Provider Demographics
NPI:1659368462
Name:LE, AUDREY H (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:H
Last Name:LE
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 1:3200 STATE STREET DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-4243
Mailing Address - Country:US
Mailing Address - Phone:901-240-7682
Mailing Address - Fax:504-866-4438
Practice Address - Street 1:1415 TULANE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-6824
Practice Address - Fax:504-866-4438
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40110207PP0204X
LA202322207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1182605Medicaid
TN3334054Medicare ID - Type Unspecified
LA1182605Medicaid