Organization
PREMIER PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN L CLARK JR. MD (OWNER)
(318) 767-1543
Entity
Organization
Contact information
Practice address
1405 METRO DR, BLDG L, ALEXANDRIA, LA 71301-3448
(318) 767-1543
(318) 767-1110
Mailing address
PO BOX 12610, ALEXANDRIA, LA 71315-2610
(318) 767-1543
(318) 767-1110
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD021955
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1682136
—
LA
Enumeration date
12/05/2005
Last updated
08/22/2020
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