Provider Demographics
NPI:1992894778
Name:LOUISSAINT, EDDY JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:EDDY
Middle Name:JOSEPH
Last Name:LOUISSAINT
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 1:3241 EXECUTIVE WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3931
Mailing Address - Country:US
Mailing Address - Phone:954-985-6500
Mailing Address - Fax:954-967-8419
Practice Address - Street 1:601 N CONGRESS AVE
Practice Address - Street 2:#404
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445
Practice Address - Country:US
Practice Address - Phone:561-272-7714
Practice Address - Fax:501-276-9845
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50401207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F82510Medicare UPIN
25199AMedicare ID - Type Unspecified