Provider Demographics
NPI:1740287820
Name:SERRANT, PEDRO A (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:A
Last Name:SERRANT
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 1:1850 GAUSE BLVD E
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5442
Mailing Address - Country:US
Mailing Address - Phone:985-646-4464
Mailing Address - Fax:985-646-4475
Practice Address - Street 1:1850 GAUSE BLVD E
Practice Address - Street 2:SUITE 103
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5442
Practice Address - Country:US
Practice Address - Phone:985-646-4464
Practice Address - Fax:985-646-4475
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08708R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1915777Medicaid
A96634Medicare UPIN
5N508Medicare ID - Type Unspecified