Provider Demographics
NPI:1154407369
Name:LE, ELIZABETH (DPM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 SOUTH RANGE AVE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726
Mailing Address - Country:US
Mailing Address - Phone:225-667-6497
Mailing Address - Fax:225-791-3899
Practice Address - Street 1:1524 SOUTH RANGE AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726
Practice Address - Country:US
Practice Address - Phone:225-667-6497
Practice Address - Fax:225-791-3899
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD173R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA231-2940OtherAETNA HMO
LA1685089Medicaid
LA215-4406OtherAETNA HMO
LAC2580OtherBLUE CROSS BLUE SHIELD
LA2700152OtherUNITED HEALTHCARE
LA212129OtherCOVENTRY HEALTHCARE
LA578-2446OtherAETNA PPO
LA6981998-001OtherCIGNA HEALTHCARE
LA578-2446OtherAETNA PPO
LA215-4406OtherAETNA HMO
LA212129OtherCOVENTRY HEALTHCARE
LA1246390002Medicare NSC
LA1246390001Medicare NSC