Healthcare Provider Details

I. General information

NPI: 1396743712
Provider Name (Legal Business Name): STUART C HEAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 NORTH BLVD STE 1
ALEXANDRIA LA
71301-3606
US

IV. Provider business mailing address

PO BOX 6284
ALEXANDRIA LA
71307-6284
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-8399
  • Fax: 318-448-9897
Mailing address:
  • Phone: 318-442-8399
  • Fax: 318-448-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number10575R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10575R
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number10575R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: