Provider Demographics
NPI:1154383925
Name:JEFF DAVIS RADIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:JEFF DAVIS RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALDES
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROZAS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:337-824-4403
Mailing Address - Street 1:PO BOX 1128
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-1128
Mailing Address - Country:US
Mailing Address - Phone:337-824-4403
Mailing Address - Fax:337-824-9731
Practice Address - Street 1:1634 ELTON RD
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3614
Practice Address - Country:US
Practice Address - Phone:337-824-4403
Practice Address - Fax:337-824-9731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1944793Medicaid
LA1944793Medicaid