Provider Demographics
NPI:1487896122
Name:WETSMAN FORENSIC MEDICINE LLC
Entity type:Organization
Organization Name:WETSMAN FORENSIC MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:WETSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-430-0578
Mailing Address - Street 1:4540 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:SUITE C-110
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6928
Mailing Address - Country:US
Mailing Address - Phone:337-326-4619
Mailing Address - Fax:504-894-8744
Practice Address - Street 1:3600 PRYTANIA ST
Practice Address - Street 2:SUITE 72
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3628
Practice Address - Country:US
Practice Address - Phone:504-894-8322
Practice Address - Fax:504-894-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty