Provider Demographics
NPI:1205882271
Name:SONDES, SCOTT M (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:SONDES
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 1:1016 1/2W 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7443
Mailing Address - Country:US
Mailing Address - Phone:985-249-6169
Mailing Address - Fax:985-249-6189
Practice Address - Street 1:1016 1/2W 21ST AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7443
Practice Address - Country:US
Practice Address - Phone:985-249-6169
Practice Address - Fax:985-249-6189
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024417208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00171224OtherRAILROAD MEDICARE
LA1570699Medicaid
H21800Medicare UPIN
5H514Medicare ID - Type Unspecified