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Organization

EXECUTIVE MEDICAL CLINIC OF LAKE CHARLES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MELISSA LEBRUN DNP (PRESIDENT)
(225) 939-0050
Entity
Organization

Contact information

Practice address
765 EAST BAYOU PINES DRIVE, LAKE CHARLES, LA 70601-5690
(337) 210-1260
Mailing address
765 EAST BAYOU PINES DRIVE, LAKE CHARLES, LA 70601-5690
(337) 210-1260

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
AP06496
LA

Other

Enumeration date
07/14/2017
Last updated
09/19/2022
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