Provider Demographics
NPI:1255433066
Name:LEDOUX, ELMA IRELAND (MD)
Entity type:Individual
Prefix:DR
First Name:ELMA
Middle Name:IRELAND
Last Name:LEDOUX
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 1:1326 FERN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-4022
Mailing Address - Country:US
Mailing Address - Phone:504-289-3610
Mailing Address - Fax:504-988-1600
Practice Address - Street 1:300 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5540
Practice Address - Country:US
Practice Address - Phone:985-646-6556
Practice Address - Fax:985-690-7198
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16097207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB65331Medicare UPIN