Individual
MR. SUBODH BHAKTA UPRETY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2408 BROADMOOR BLVD, SUITE 2, MONROE, LA 71201-2963
(318) 807-0525
(318) 807-1107
Mailing address
130 DESIARD STREET, SUITE 355, MONROE, LA 71201-7363
(318) 807-7875
(318) 812-6603
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD205649
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1887358
—
LA
Enumeration date
08/20/2009
Last updated
01/15/2016
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