Organization
SLIDELL INTERNAL MEDICINE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLAN QUIBILAN LARCENA MD (OWNER)
(985) 646-0123
Entity
Organization
Contact information
Practice address
105 MEDICAL CENTER DR, SUITE 301, SLIDELL, LA 70461-5544
(985) 646-0123
(985) 641-0330
Mailing address
105 MEDICAL CENTER DR, SUITE 301, SLIDELL, LA 70461-5544
(985) 646-0123
(985) 641-0330
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11339R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1662097
—
LA
Enumeration date
05/09/2007
Last updated
12/28/2007
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