Organization
PERFUSION VASCULAR VIDALIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN R CARPENTER M.D. (OWNER)
(985) 892-7070
Entity
Organization
Contact information
Practice address
107 FRONT ST, VIDALIA, LA 71373-2836
(985) 892-7070
(985) 892-7017
Mailing address
PO BOX 1089, HAMMOND, LA 70404
(985) 892-7070
(985) 892-7017
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
04/13/2017
Last updated
06/25/2021
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