Provider Demographics
NPI:1134180011
Name:ESCIPION PEDROZA
Entity type:Organization
Organization Name:ESCIPION PEDROZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOZEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-454-2260
Mailing Address - Street 1:1700 CANNES DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2407
Mailing Address - Country:US
Mailing Address - Phone:985-658-1689
Mailing Address - Fax:985-652-1778
Practice Address - Street 1:1700 CANNES DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2407
Practice Address - Country:US
Practice Address - Phone:985-658-1689
Practice Address - Fax:985-652-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAM.D.05646R207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1319643Medicaid
LA1319643Medicaid
LAB65318Medicare UPIN
LA56946Medicare ID - Type UnspecifiedMETAIRIE