Individual
CHARLES A MCINTOSH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2408 BROADMOOR BLVD, MONROE, LA 71201-2963
(318) 410-0002
Mailing address
PO BOX 235022, MONTGOMERY, AL 36123-5022
(800) 897-6169
(800) 897-6170
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
020634
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962961
—
LA
01
—
P00092000
MEDICARE RAILROAD
LA
Enumeration date
08/23/2006
Last updated
03/06/2012
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