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Organization
DEIDRE L STELLY MD APMLLC
Active
Organization
DEIDRE L STELLY MD APMLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEIDRE L STELLY MD (OWNER)
(337) 261-5151
Entity
Organization
Contact information
Practice address
112 CHAMPAGNE BLVD, BREAUX BRIDGE, LA 70517-3852
(337) 261-5151
Mailing address
112 CHAMPAGNE BLVD, BREAUX BRIDGE, LA 70517-3852
(337) 332-2242
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1443077
—
LA
Enumeration date
10/06/2005
Last updated
03/10/2008
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