Organization
PETER HERTZAK M.D. PMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER H HERTZAK (OWNER)
(985) 641-6300
Entity
Organization
Contact information
Practice address
985 ROBERT BLVD STE 102, SLIDELL, LA 70458-2063
(985) 641-6300
(985) 646-1409
Mailing address
985 ROBERT BLVD STE 102, SLIDELL, LA 70458-2063
(985) 641-6300
(985) 646-1409
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
05273R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1311308
—
LA
Enumeration date
02/16/2009
Last updated
04/15/2009
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