Provider Demographics
NPI:1063516151
Name:PADGETT, PHILIP G (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:G
Last Name:PADGETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8490 PICARDY AVE
Mailing Address - Street 2:BLDG 200
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3731
Mailing Address - Country:US
Mailing Address - Phone:225-237-1754
Mailing Address - Fax:225-237-1722
Practice Address - Street 1:610 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767
Practice Address - Country:US
Practice Address - Phone:225-267-6626
Practice Address - Fax:225-267-5993
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA019597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1378437Medicaid
LA19D1000495OtherCLIA#
LA930071021OtherRRR
LA930071021OtherRRR
LABP1834971OtherDEA
LA338736YNB7Medicare PIN