Provider Demographics
NPI:1336175934
Name:PARRIS, CORDEL YVETTE (MD)
Entity type:Individual
Prefix:DR
First Name:CORDEL
Middle Name:YVETTE
Last Name:PARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 WABASH BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3838
Mailing Address - Country:US
Mailing Address - Phone:225-757-6700
Mailing Address - Fax:225-757-6711
Practice Address - Street 1:236 WABASH BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-757-6700
Practice Address - Fax:225-757-6711
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.15606R207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1462748Medicaid
LA1462748Medicaid
LA5CU47Medicare PIN
LAI17367Medicare UPIN