Organization
PELICAN MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LETHA HAYNES RRT (OWNER)
(504) 355-7453
Entity
Organization
Contact information
Practice address
7 LAGI ST, LA PLACE, LA 70068-8408
(504) 355-7453
Mailing address
54 VETERANS BLVD, DONALDSONVILLE, LA 70346-2450
(504) 355-7453
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
RRT 421
LA
Other
Enumeration date
10/13/2014
Last updated
10/13/2014
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