Individual
RIA ITTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4811 AMBASSADOR CAFFERY PKWY STE 401A, LAFAYETTE, LA 70508-7265
(337) 470-3040
(337) 470-3043
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 765-5727
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
328120
LA
390200000X
Student in an Organized Health Care Education/Training Program
63609
NY
Other
Enumeration date
07/14/2015
Last updated
07/27/2021
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