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Organization

ALICE ROBERT, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. KELLI D. BEAVERS (CREDENTIALING MANAGER)
(318) 325-6200
Entity
Organization

Contact information

Practice address
106 S LINCOLN ST, TALLULAH, LA 71282-4546
(504) 782-7848
(318) 574-3900
Mailing address
106 S LINCOLN ST, TALLULAH, LA 71282-4546
(504) 782-7848
(318) 574-3900

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD.025610
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1042935
LA
Enumeration date
05/02/2012
Last updated
05/02/2012
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