Individual
JEROME THADDEUS MEDLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 MEADOWCREST ST, SUITE 330, GRETNA, LA 70056-5255
(504) 391-7560
(504) 394-2269
Mailing address
4710 OWENS BLVD, NEW ORLEANS, LA 70122-1227
(504) 283-0701
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3145R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1121335
—
LA
Enumeration date
03/15/2007
Last updated
07/08/2007
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