Individual
DR. KODI FAY CRISP-COLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9001 SUMMA AVENUE, BATON ROUGE, LA 70809-3726
(225) 761-5480
Mailing address
1514 JEFFERSON HIGHWAY, NEW ORLEANS, LA 70121
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
GETP.EBR.FP
LA
207Q00000X
Family Medicine Physician
Primary
MD.204059
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08077518
—
MS
05
—
1000281
—
LA
01
—
GETP.EBR.FP
TEMPORARY LICENSE NUMBER
LA
Enumeration date
02/18/2008
Last updated
12/06/2010
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