Healthcare Provider Details

I. General information

NPI: 1366452807
Provider Name (Legal Business Name): BRIAN LANE ELKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N BOLTON AVE STE A
ALEXANDRIA LA
71301-7460
US

IV. Provider business mailing address

1201 N BOLTON AVE STE A
ALEXANDRIA LA
71301-7460
US

V. Phone/Fax

Practice location:
  • Phone: 318-441-2220
  • Fax: 318-441-2205
Mailing address:
  • Phone: 318-441-2220
  • Fax: 318-441-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.13101R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberMD.13101R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: