Basic Information
| Provider Information | |||||||||
| NPI: | 1578699138 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARADOX INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 E SHANKLAND AVE | ||||||||
| Address2: | |||||||||
| City: | JENNINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705464709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665466643 | ||||||||
| FaxNumber: | 3378248726 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 E SHANKLAND AVE | ||||||||
| Address2: | |||||||||
| City: | JENNINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705464709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665466643 | ||||||||
| FaxNumber: | 3378248726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 11/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | INGRAM | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8665466643 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD.201213 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.