Provider Demographics
NPI:1255340949
Name:BLAUDEAU, ERICK (MD)
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:BLAUDEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-3470
Practice Address - Fax:504-842-7372
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1348392085R0202X
LAMD.09984R2085R0202X
MI43010873892085R0202X
MS205472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
EB087389OtherCHAMPUS-CHAMPUS
MS05935300Medicaid
AL178942Medicaid
MI488419210Medicaid
EB087389OtherCOMMERCIAL-COMMERCIAL NUMBER
700H262300OtherBLUE CROSS-BLUE CROSS
MSP00771083Medicare PIN
EB087389OtherCOMMERCIAL-COMMERCIAL NUMBER
700H262300OtherBLUE CROSS-BLUE CROSS
MS512I300191Medicare PIN