Organization
FERTILE CRESCENT PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN DESPINASSE II M.D. (CEO)
(225) 924-7343
Entity
Organization
Contact information
Practice address
730 COLONIAL DR, SUITE B, BATON ROUGE, LA 70806-6536
(225) 924-7343
(225) 924-7347
Mailing address
730 COLONIAL DR, SUITE B, BATON ROUGE, LA 70806-6536
(225) 924-7343
(225) 924-7347
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
023350
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1490903
—
LA
Enumeration date
10/13/2009
Last updated
10/13/2009
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