Provider Demographics
NPI:1124123526
Name:DEJEAN, JOSEPH EDWIN JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDWIN
Last Name:DEJEAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:721 LOWERLINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5113
Mailing Address - Country:US
Mailing Address - Phone:504-866-1440
Mailing Address - Fax:
Practice Address - Street 1:1601 PERDIDO ST
Practice Address - Street 2:SOUTHEAST LOUISIANA VETERANS HEALTH CARE SYSTEM
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-568-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA168212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology