Provider Demographics
NPI:1780095224
Name:FIDONE, ERICA JOY (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:JOY
Last Name:FIDONE
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 1:225 DUNN ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4440
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-876-5529
Practice Address - Street 1:302 MEDICAL PARK DR STE 104
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3129
Practice Address - Country:US
Practice Address - Phone:936-633-1230
Practice Address - Fax:936-630-2078
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2587207RI0011X
LA325614207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease