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NPI Code Detail

MEDICARE: DR. ELIZABETH A CLUBB M.D.

MEDICARE:  DR. ELIZABETH A CLUBB  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistMD.11291RLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437317260
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH A CLUBB M.D.
Provider Business Mailing Address
First Line : 4864 BLUEBONNET BLVD
Second Line : SUITE A
City : BATON ROUGE
State : LA
Zip : 70809-9644
Country : US
Telephone Number : 225-766-7771
Fax Number : 225-766-7995
Provider Business Practice Location Address
First Line : 4864 BLUEBONNET BLVD
Second Line : SUITE A
City : BATON ROUGE
State : LA
Zip : 70809-9644
Country : US
Telephone Number : 225-766-7771
Fax Number : 225-766-7995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2008
Last Update Date : 05/29/2008

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