| NPI | 1538397542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J SCREPETIS Designated Registered Agent 318-445-9823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 018528) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 018963) |
| 207Q00000X Family Medicine (Licence: LA 015029) | |
| 207R00000X Internal Medicine (Licence: LA 024254) | |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: LA 019187) | |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: LA 303310) | |
| 213E00000X Podiatrist (Licence: LA pd20512) | |
| 213E00000X Podiatrist (Licence: LA 200010) | |
| 363L00000X Nurse Practitioner (Licence: LA ap01177) | |
| 363L00000X Nurse Practitioner (Licence: LA ap06478) | |
| 363L00000X Nurse Practitioner (Licence: LA ap0338) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2017-02-13 |