Organization
NORTHEAST RENAL & DIALYSIS, A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID EARL PRUETT M.D. (PRESIDENT/OWNER)
(318) 325-5435
Entity
Organization
Contact information
Practice address
1908 ROYAL AVE, MONROE, LA 71201-5724
(318) 325-5435
(318) 325-8852
Mailing address
1908 ROYAL AVE, MONROE, LA 71201-5724
(318) 325-5435
(318) 325-8852
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD.204452
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2152203
—
LA
Enumeration date
03/14/2014
Last updated
10/22/2014
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