Individual
DR. CHARLES P BURNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2916 N UNIVERSITY AVE, LAFAYETTE, LA 70507-4039
(337) 291-1555
Mailing address
509 BEVERLY DR, LAFAYETTE, LA 70503-3113
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
022219
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04866
BCBS
LA
05
—
1675695
—
LA
Enumeration date
06/14/2006
Last updated
02/11/2013
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