| Doctor Name: | DR. JOEL E PERDOMO |
| NPI Number: | 1003128463 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 207966 |
| Business Practice Address: | 2104 Gause Blvd W Slidell, LA - 704604130 |
| Business Phone Number: | 9856434575 |
| Business Fax Number: | 9856434513 |
| Mailing Address: | 1521 Tidewater Dr, SLIDELL |
| State: | LA |
| Postal Code: | 704585385 |
| Phone Number: | 7187556090 |
| Fax Number: | |
| NPI Enumeration Date: | 07/13/2010 |
| NPI Last Update Date: | 10/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 207966 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |