Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY LIMBOCKER (CFO)
(225) 765-7727
Entity
Organization
Contact information
Practice address
7777 HENNESSY BLVD, STE 6002, BATON ROUGE, LA 70808-4300
(225) 765-7727
(225) 766-5645
Mailing address
2051 SILVERSIDE DR, STE 260, BATON ROUGE, LA 70808-9005
(225) 490-6301
(225) 765-9539
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207SG0201X
Clinical Genetics (M.D.) Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208200000X
Plastic Surgery Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
208M00000X
Hospitalist Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2305042
—
LA
Enumeration date
10/12/2011
Last updated
10/08/2015
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