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Individual

JOHNNY RAY BIDDLE JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3608 KIRKMAN ST, LAKE CHARLES, LA 70607-3006
(337) 936-6893
(337) 564-0931
Mailing address
630 W PRIEN LAKE RD, B 210, LAKE CHARLES, LA 70601-0700
(337) 936-6893
(337) 564-0931

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
05629R
LA
207Q00000X
Family Medicine Physician
Primary
05629R
LA
208D00000X
General Practice Physician
05629R
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1347795
LA
Enumeration date
05/09/2007
Last updated
11/10/2015
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