Organization
PRIDE PLAZA MEDICAL LLC
Active
Other names
Stephens Johnny J Member
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES MWAKITAWA MWATIBO MD, PHD (PARTNER/MD)
(337) 233-2115
Entity
Organization
Contact information
Practice address
850 N PIERCE STREET, SUITE D, LAFAYETTE, LA 70501-2848
(337) 233-2115
(337) 237-9075
Mailing address
850 N PIERCE STREET, SUITE D, LAFAYETTE, LA 70501-2848
(337) 233-2115
(337) 237-9075
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1443522
—
LA
Enumeration date
10/06/2005
Last updated
10/07/2010
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