Provider Demographics
NPI:1033153861
Name:SPILLER, EDMUND OGDEN (MD)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:OGDEN
Last Name:SPILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 S MORRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5742
Mailing Address - Country:US
Mailing Address - Phone:985-230-5800
Mailing Address - Fax:985-230-5859
Practice Address - Street 1:1902 S MORRISON BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5742
Practice Address - Country:US
Practice Address - Phone:985-230-5800
Practice Address - Fax:985-230-5859
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.011342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1327280Medicaid
55915Medicare ID - Type Unspecified
LA1327280Medicaid