Individual
DR. JUDITH CANELLA BLAISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
602 N ACADIA RD, THIBODAUX, LA 70301-4823
(985) 493-4706
(985) 449-2595
Mailing address
PO BOX 5237, THIBODAUX, LA 70302-5237
(985) 803-0584
(985) 449-0700
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
020707
LA
207VX0000X
Obstetrics Physician
Primary
MD.020707
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1540161
—
LA
Enumeration date
06/17/2006
Last updated
01/09/2019
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