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Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Active
Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Active
Other names
OLOL Physician Surgical Specialty
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA WHITE (DIRECTOR OF BUSINESS SERVICES)
(225) 765-5727
Entity
Organization
Contact information
Practice address
4950 ESSEN LN, BATON ROUGE, LA 70809-3738
(225) 767-1311
(225) 767-1335
Mailing address
8415 GOODWOOD BLVD, STE 105, BATON ROUGE, LA 70806-7851
(225) 765-5727
(225) 765-4278
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
208600000X
Surgery Physician
—
—
2086S0127X
Trauma Surgery Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05684711
—
MS
05
—
1447218
—
LA
Enumeration date
05/30/2006
Last updated
02/20/2013
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