Individual
JORGE RAFAEL BELGODERE-BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
811 ALBERTSON PKWY STE F, BROUSSARD, LA 70518-5256
(337) 837-3615
(337) 839-8097
Mailing address
811 ALBERTSON PKWY STE F, BROUSSARD, LA 70518-5256
(337) 837-3615
(337) 839-8097
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD025916
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1545619
—
LA
01
—
5CS48
MEDICARE
LA
Enumeration date
08/21/2006
Last updated
09/12/2022
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