Provider Demographics
NPI:1134565112
Name:PEDIATRIC ASSOCIATES OF DENHAM SPRINGS
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF DENHAM SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ZGANJAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-933-0090
Mailing Address - Street 1:1211 N RANGE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-2428
Mailing Address - Country:US
Mailing Address - Phone:225-933-0090
Mailing Address - Fax:225-665-0055
Practice Address - Street 1:1211 N RANGE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-2428
Practice Address - Country:US
Practice Address - Phone:225-933-0090
Practice Address - Fax:225-665-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07255363LP0200X
LA022406208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty