Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 322103 | LA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 322103 | LA |
NPI | 1235484189 |
---|---|
Provider Name | Michelle R Beurlot |
First Address | Alexandria, LA 71303-4255 |
Second Address | Alexandria, LA 71303-4255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 15/10/2020 |