Provider Demographics
NPI:1740286319
Name:ORDENEAUX, AMY RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:RUSSELL
Last Name:ORDENEAUX
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Gender:F
Credentials:MD
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Mailing Address - Street 1:LOUISIANA STATE UNIVERSITY STUDENT HEALTH CTR
Mailing Address - Street 2:INFIRMARY ROAD
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70803-0001
Mailing Address - Country:US
Mailing Address - Phone:225-578-6271
Mailing Address - Fax:225-578-5282
Practice Address - Street 1:LOUISIANA STATE UNIVERSITY STUDENT HEALTH CTR
Practice Address - Street 2:INFIRMARY ROAD
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70803-0001
Practice Address - Country:US
Practice Address - Phone:225-578-6271
Practice Address - Fax:225-578-5282
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-04-11
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Provider Licenses
StateLicense IDTaxonomies
LA023810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1482781Medicaid
LA1482781Medicaid
H29299Medicare UPIN