Provider Demographics
NPI:1689647430
Name:DESPER, BEATRICE S (MD)
Entity Type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:S
Last Name:DESPER
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 1:1120 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3209
Mailing Address - Country:US
Mailing Address - Phone:985-674-9720
Mailing Address - Fax:985-674-4374
Practice Address - Street 1:1120 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3209
Practice Address - Country:US
Practice Address - Phone:985-674-4434
Practice Address - Fax:985-674-4374
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15436R207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4K703CY96OtherMEDICARE INDIVIDUAL PTAN
LA1469742Medicaid