Provider Demographics
NPI:1033571914
Name:EHRHARDT, KEN PHILIP JR
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:PHILIP
Last Name:EHRHARDT
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16070 DOCTORS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1478
Mailing Address - Country:US
Mailing Address - Phone:985-345-7246
Mailing Address - Fax:
Practice Address - Street 1:16070 DOCTORS BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1478
Practice Address - Country:US
Practice Address - Phone:985-345-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324535208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine