Provider Demographics
NPI:1306807771
Name:PEDROZA, ESCIPION (MD)
Entity type:Individual
Prefix:DR
First Name:ESCIPION
Middle Name:
Last Name:PEDROZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 SAXON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4187
Mailing Address - Country:US
Mailing Address - Phone:504-454-2816
Mailing Address - Fax:504-455-5684
Practice Address - Street 1:4213 SAXON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4187
Practice Address - Country:US
Practice Address - Phone:504-454-2816
Practice Address - Fax:504-455-5684
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAM.D.05646R207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1319643Medicaid
LA56946Medicare ID - Type UnspecifiedMETAIRIE
LAB65318Medicare UPIN
LA54555Medicare ID - Type UnspecifiedLAPLACE