Organization
SOUTHEAST NEUROSCIENCE CENTER, LLC
Active
Organization
SOUTHEAST NEUROSCIENCE CENTER, LLC
Active
Other names
Southeast Neuroscience Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GABRIEL LEE NUGENT (DIRECTOR)
(985) 850-6805
Entity
Organization
Contact information
Practice address
970 S ACADIA RD, THIBODAUX, LA 70301-4978
(985) 917-3007
(985) 447-4209
Mailing address
PO BOX 4051, HOUMA, LA 70361-4051
(985) 917-3007
(985) 917-3010
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1947482
—
LA
Enumeration date
05/28/2015
Last updated
11/05/2015
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