Provider Demographics
NPI:1750452470
Name:MAGAZINE RETINAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:MAGAZINE RETINAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLEY
Authorized Official - Middle Name:GUSTAVO
Authorized Official - Last Name:JARAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-592-9818
Mailing Address - Street 1:4747 EARHART BLVD
Mailing Address - Street 2:STE J
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-1743
Mailing Address - Country:US
Mailing Address - Phone:504-592-9818
Mailing Address - Fax:504-525-0152
Practice Address - Street 1:4747 EARHART BLVD
Practice Address - Street 2:STE J
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1743
Practice Address - Country:US
Practice Address - Phone:504-592-9818
Practice Address - Fax:504-525-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9487207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1449628Medicaid
LA1449628Medicaid