Organization
SOUTHERN PINES FAMILY MEDICAL
Active
Other names
Southern Pines Family Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN BUTT M D (MEMBER)
(985) 863-7100
Entity
Organization
Contact information
Practice address
64629 HIGHWAY 41, PEARL RIVER, LA 70452-3611
(985) 863-7100
Mailing address
PO BOX 1659, PEARL RIVER, LA 70452-1659
(985) 863-7100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1439959
—
LA
Enumeration date
10/05/2006
Last updated
06/08/2011
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