Organization
LEO BLAIZE III MD
Active
Other names
LAKE INTERNAL MEDICINE AT HENNESSY
Organization subpart
No
Provider details
NPI number
Authorized official
MYRTHA AVANTS (SR REGION OPERATIONS MANAGER)
(225) 202-8078
Entity
Organization
Contact information
Practice address
7777 HENNESSY BLVD, STE 7000, BATON ROUGE, LA 70808-4300
(225) 765-8829
(225) 765-8283
Mailing address
7777 HENNESSY BLVD, STE 7000, BATON ROUGE, LA 70808-4300
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
015394
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932943
OTHER ID NUMBER
—
Enumeration date
11/20/2006
Last updated
11/21/2007
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