Basic Information
| Provider Information | |||||||||
| NPI: | 1740329978 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WALTER R ABBOTT MD, APMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2633 NAPOLEON AVE | ||||||||
| Address2: | SUITE #400 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701156357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047382431 | ||||||||
| FaxNumber: | 5047382430 | ||||||||
| Practice Location | |||||||||
| Address1: | 2633 NAPOLEON AVE | ||||||||
| Address2: | SUITE #400 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701156357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047382431 | ||||||||
| FaxNumber: | 5047382430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KLOTZBACH | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5047382431 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1160504 | 05 | LA | MEDICAID |