Provider Demographics
NPI:1982933867
Name:ELIZABETH LE,DPM,LLC
Entity type:Organization
Organization Name:ELIZABETH LE,DPM,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:225-667-6497
Mailing Address - Street 1:1524 S RANGE AVE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-5218
Mailing Address - Country:US
Mailing Address - Phone:225-667-6497
Mailing Address - Fax:225-791-3899
Practice Address - Street 1:1524 S RANGE AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-5218
Practice Address - Country:US
Practice Address - Phone:225-667-6497
Practice Address - Fax:225-791-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD173R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1685089Medicaid
LA2700152OtherUNITED HEALTH CARE
LAC2580OtherBLUE CROSS BLUE SHIELD
LA2700152OtherUNITED HEALTH CARE
LAU61928Medicare UPIN
LA1246390001Medicare NSC
LA5W883Medicare PIN
LA5H190Medicare PIN