Individual
DR. ANDREA NATALIE BLAKE-MCMAHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
129 MINDEN SHOPPING DR, MINDEN, LA 71055-2770
(318) 377-2007
(318) 377-3099
Mailing address
1007 GOULD DR, STE 1, BOSSIER CITY, LA 71111-4971
(318) 377-2007
(318) 377-3099
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
14851R
LA
208000000X
Pediatrics Physician
14851R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1150185
—
LA
Enumeration date
04/19/2006
Last updated
05/06/2016
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