Organization
VICTOR THERIAULT MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR THERIAULT (PRESIDENT)
(985) 732-4853
Entity
Organization
Contact information
Practice address
712 WILLIS AVE, BOGALUSA, LA 70427-3004
(985) 732-4853
Mailing address
712 WILLIS AVE, BOGALUSA, LA 70427-3004
(985) 732-4853
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/01/2006
Last updated
08/22/2020
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