Provider Demographics
NPI:1124283163
Name:MEDICAL PLAZA ENT PHYSICIANS A PROFESSIONAL MEDICAL CORP
Entity type:Organization
Organization Name:MEDICAL PLAZA ENT PHYSICIANS A PROFESSIONAL MEDICAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-455-3434
Mailing Address - Street 1:4228 HOUMA BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-3000
Mailing Address - Country:US
Mailing Address - Phone:504-455-3434
Mailing Address - Fax:504-455-5477
Practice Address - Street 1:4228 HOUMA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3000
Practice Address - Country:US
Practice Address - Phone:504-455-3434
Practice Address - Fax:504-455-5477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty