Organization
BOGALUSA FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELVIN LESTER (BILLING CLERK)
(985) 732-1899
Entity
Organization
Contact information
Practice address
433 PLAZA ST, BOGALUSA, LA 70427-3729
(985) 735-1198
Mailing address
PO BOX 700, BOGALUSA, LA 70429-0700
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
MD107924
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1365858
—
LA
Enumeration date
05/29/2008
Last updated
05/29/2008
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