Provider Demographics
NPI:1992864128
Name:SEDRISH, PHILLIP PAUL (MD, FACR)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:PAUL
Last Name:SEDRISH
Suffix:
Gender:M
Credentials:MD, FACR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 GAUSE BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2986
Mailing Address - Country:US
Mailing Address - Phone:985-280-6770
Mailing Address - Fax:985-280-6771
Practice Address - Street 1:1051 GAUSE BLVD
Practice Address - Street 2:# 440
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-280-6770
Practice Address - Fax:985-280-6771
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.07700R207RR0500X
LAMD07700R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology