Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 015760 | LA |
NPI | 1063472264 |
---|---|
Provider Name | Dr. John C Beatrous |
First Address | Covington, LA 70433-7514 |
Second Address | Covington, LA 70433-7514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 30/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1348368 | (05) | LA |
B61971 | (02) | LA |