Organization
ST JUDE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUDE AGENDIA M.D. (OWNER)
(337) 564-6722
Entity
Organization
Contact information
Practice address
4150 NELSON RD, BLDG E SUITE 4, LAKE CHARLES, LA 70605-4148
(337) 564-6722
Mailing address
4150 NELSON RD, BLDG E SUITE 4, LAKE CHARLES, LA 70605-4148
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
03/04/2013
Last updated
03/04/2013
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