Individual
DR. THERESA LYNN DISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 BROADWAY ST, SUITE 230, NEW ORLEANS, LA 70118-3557
(504) 988-9000
(504) 988-9099
Mailing address
1430 TULANE AVE, SL-37, NEW ORLEANS, LA 70112-2632
(504) 988-5001
(504) 988-9099
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
07313R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1378291
—
LA
Enumeration date
09/29/2006
Last updated
06/20/2011
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