Organization
UROLOGY CLINIC OF NORTHEAST LOUISIANA - A MEDICAL CORPORATION
Active
Other names
Urology Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JON BRADLEY JOHNSON MD (PHYSICIAN OWNER)
(318) 387-9420
Entity
Organization
Contact information
Practice address
711 SAINT JOHN STREET, MONROE, LA 71201-8435
(318) 387-9420
(318) 323-8216
Mailing address
711 SAINT JOHN STREET, MONROE, LA 71201-8435
(318) 387-9420
(318) 323-8216
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
013314
LA
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1106607
—
LA
Enumeration date
06/24/2006
Last updated
10/19/2012
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