Organization
PATHOLOGY LABORATORY CONSULTANTS APMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD MILBURN NUNNALLY M.D. (OWNER)
(318) 677-7450
Entity
Organization
Contact information
Practice address
3933 CONVENTION ST, BATON ROUGE, LA 70806-3806
(225) 387-7851
Mailing address
PO BOX 1736, SHREVEPORT, LA 71166-1736
(318) 677-7450
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
007053
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015398
—
MS
05
—
1317055
—
LA
01
—
220009443
RAILROAD MEDICARE
LA
Enumeration date
11/07/2007
Last updated
06/18/2008
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