Individual
ANGELIQUE BLAIR CARMOUCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAT, LAT,ATC
Contact information
Practice address
ASU STATION #10899, SAN ANGELO, TX 76909-0001
(940) 435-4347
Mailing address
LSU ATHLETIC ADMINISTRATION BUILDING, BATON ROUGE, LA 70803-0001
(225) 578-8001
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
319966
LA
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
AT8258
TX
Other
Enumeration date
06/28/2019
Last updated
01/25/2021
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