Individual
DR. DOMINIQUE J. BEAUDRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
312596
LA
207RC0000X
Cardiovascular Disease Physician
312596
LA
207RC0000X
Cardiovascular Disease Physician
M9151
TX
207RI0011X
Interventional Cardiology Physician
Primary
312596
LA
207RI0011X
Interventional Cardiology Physician
M9151
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197375201
—
TX
05
—
197375205
—
TX
05
—
197375206
—
TX
01
—
197375207
CSHCN
TX
Enumeration date
11/08/2007
Last updated
08/18/2023
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