Organization
ASHLEY RIDGE MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHI TAI PETER LAU M. D. (PHYSICIAN / PROVIDER / OWNER)
(318) 645-6161
Entity
Organization
Contact information
Practice address
1015 OBRIE ST, ZWOLLE, LA 71486-2510
(318) 645-6161
(318) 798-4601
Mailing address
PO BOX 5313, SHREVEPORT, LA 71135-5313
(318) 645-6161
(318) 798-4601
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23409
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1494909
—
LA
01
—
DG4348
RAILROAD MEDICARE GROUP NUMBER
LA
Enumeration date
09/14/2007
Last updated
08/23/2024
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