Organization
EAST BAYOU MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL EUGENE FENN JR. MD (PHYSICIAN)
(337) 269-0136
Entity
Organization
Contact information
Practice address
204 ENERGY PKWY, SUITE B, LAFAYETTE, LA 70508-3816
(337) 269-0136
(337) 233-8525
Mailing address
204 ENERGY PKWY, SUITE B, LAFAYETTE, LA 70508-3816
(337) 269-0136
(337) 233-8525
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
MD200825
LA
Other
Enumeration date
09/13/2011
Last updated
09/13/2011
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