Basic Information
| Provider Information | |||||||||
| NPI: | 1629343959 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BORDELON | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | DOUCET | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7373 PERKINS RD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252469790 | ||||||||
| FaxNumber: | 2252469100 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 ROBERTS DR | ||||||||
| Address2: | SUITE I | ||||||||
| City: | NEW ROADS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707602661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256384585 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2012 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 206276 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 206276 | 01 | LA | STATE LICENSES | OTHER | 2199056 | 05 | LA | MEDICAID |