Organization
L GLEN MIRE MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOUIS GLEN MIRE MD (OWNER)
(337) 981-0305
Entity
Organization
Contact information
Practice address
324 DULLES DR, LAFAYETTE, LA 70506-3008
(337) 981-0305
Mailing address
PO BOX 61950, LAFAYETTE, LA 70596-1950
(337) 981-0305
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
012202
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1197386
—
LA
Enumeration date
07/12/2007
Last updated
05/21/2008
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