| NPI | 1750691341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL W DUPRE Doctor 225-755-3070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: LA MD.022121) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: LA 022121) |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2012-03-16 |