Provider Demographics
NPI:1134176183
Name:RODRIGUE, LESLIE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:RODRIGUE
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 1:4200 HOUMA BLVD
Mailing Address - Street 2:FL 6
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2970
Mailing Address - Country:US
Mailing Address - Phone:504-503-4331
Mailing Address - Fax:504-503-4341
Practice Address - Street 1:4200 HOUMA BLVD
Practice Address - Street 2:FL 6
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2970
Practice Address - Country:US
Practice Address - Phone:504-503-4331
Practice Address - Fax:504-503-4341
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.10704R207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1681865Medicaid
G37709Medicare UPIN
LA5Y064Medicare ID - Type Unspecified