Provider Demographics
NPI:1366860603
Name:ROGER D RHOLDON JR
Entity type:Organization
Organization Name:ROGER D RHOLDON JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:MELANCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-367-2001
Mailing Address - Street 1:6100 CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-5144
Mailing Address - Country:US
Mailing Address - Phone:337-289-6770
Mailing Address - Fax:
Practice Address - Street 1:6100 CAMERON ST
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-5144
Practice Address - Country:US
Practice Address - Phone:337-289-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07699363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty