# WEST JEFFERSON PHYSICIAN SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pediatric Specialty
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669549283
- **Authorized official:** HEIDI A GWINN (CREDENTIALING COORD.)
- **Authorized official phone:** (504) 349-1297

## Contact information

- **Practice address:** 1111 MEDICAL CENTER BLVD, SUITE S650, MARRERO, LA 70072-3151
- **Practice address phone:** (504) 349-6504
- **Practice address fax:** (504) 349-6528
- **Mailing address:** 1111 MEDICAL CENTER BLVD, SUITE S650, MARRERO, LA 70072-3151
- **Mailing address phone:** (504) 349-6504
- **Mailing address fax:** (504) 349-6528

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080P0201X | Pediatric Allergy/Immunology Physician | — | NULL | Yes |
| 2080P0201X | Pediatric Allergy/Immunology Physician | — | — | Yes |
| 2080P0206X | Pediatric Gastroenterology Physician | — | NULL | — |
| 2080P0206X | Pediatric Gastroenterology Physician | — | — | — |
| 2080P0214X | Pediatric Pulmonology Physician | — | NULL | — |
| 2080P0214X | Pediatric Pulmonology Physician | — | — | — |

## Other

- **Enumeration date:** 11/29/2006
- **Last updated:** 09/11/2025