Dr Jeffrey Elting Deyo, MD, PHD | |
8300 Constantin Blvd, Baton Rouge, LA 70809-3489 | |
(225) 763-6337 | |
(225) 374-4661 |
Full Name | Dr Jeffrey Elting Deyo |
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Gender | Male |
Speciality | Pediatrics - Pediatric Hematology-oncology |
Location | 8300 Constantin Blvd, Baton Rouge, Louisiana |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1619962032 | NPI | - | NPPES |
1193500 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 15187R (Louisiana) | Secondary |
2080P0207X | Pediatrics - Pediatric Hematology-oncology | 15187R (Louisiana) | Primary |
Entity Name | Our Lady Of The Lake Physician Group Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1033494943 PECOS PAC ID: 4587849781 Enrollment ID: O20120529000377 |
Mailing Address | Practice Location Address |
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Dr Jeffrey Elting Deyo, MD, PHD 5959 S Sherwood Forest Blvd, Baton Rouge, LA 70816-6038 Ph: (225) 526-0002 | Dr Jeffrey Elting Deyo, MD, PHD 8300 Constantin Blvd, Baton Rouge, LA 70809-3489 Ph: (225) 763-6337 |
Manish Gope Raisingani, Pediatrics Medicare: Medicare Enrolled Practice Location: 8200 Constantin Blvd Fl 4, Baton Rouge, LA 70809 Phone: 225-765-5500 Fax: 225-765-1733 | |
Traci T. Lacy, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 7373 Perkins Rd, Baton Rouge, LA 70808 Phone: 225-769-4044 | |
Dr. Michelle L Flechas, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 12525 Perkins Rd, Suite C, Baton Rouge, LA 70810 Phone: 225-769-2003 Fax: 225-767-3055 | |
Dr. Richard Francis Lasseigne Jr., MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 8300 Constantin Blvd, Baton Rouge, LA 70809 Phone: 225-374-1410 Fax: 225-374-1616 | |
Dr. Horace Jay Collinsworth, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 8415 Goodwood Blvd, Suite 100, Baton Rouge, LA 70806 Phone: 225-765-5633 Fax: 225-765-5634 | |
Myriam Aracelis Ortiz-de Jesus', MD Pediatrics Medicare: Medicare Enrolled Practice Location: 11424 Sullivan Rd, Suite B1, Baton Rouge, LA 70818 Phone: 225-761-5200 | |
Kelly Elizabeth Ordemann, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 8415 Goodwood Blvd Ste 202, Baton Rouge, LA 70806 Phone: 225-765-8013 Fax: 225-765-2033 |