Provider Demographics
NPI:1366736365
Name:CHRISTIAN J. WOLD MD LLC
Entity type:Organization
Organization Name:CHRISTIAN J. WOLD MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-427-3300
Mailing Address - Street 1:221 WINDERMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3538
Mailing Address - Country:US
Mailing Address - Phone:318-427-3300
Mailing Address - Fax:318-427-3310
Practice Address - Street 1:221 WINDERMERE BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3538
Practice Address - Country:US
Practice Address - Phone:318-427-3300
Practice Address - Fax:318-427-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 202843174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1366736365OtherBLUE CROSS
LA1887137Medicaid
LA1887137Medicaid