Provider Demographics
NPI:1720195712
Name:ESCIPION PEDROZA
Entity Type:Organization
Organization Name:ESCIPION PEDROZA
Other - Org Name:METAIRIE DIABETES CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
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 1:4213 SAXON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4187
Mailing Address - Country:US
Mailing Address - Phone:504-454-2816
Mailing Address - Fax:504-455-5684
Practice Address - Street 1:4213 SAXON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4187
Practice Address - Country:US
Practice Address - Phone:504-454-2816
Practice Address - Fax:504-455-5684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CJ47Medicare ID - Type UnspecifiedMETAIRIE DIABETES CLINIC