Healthcare Provider Details

I. General information

NPI: 1073790689
Provider Name (Legal Business Name): INTERNAL MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 4TH ST # 30129
ALEXANDRIA LA
71301-8421
US

IV. Provider business mailing address

201 4TH ST STE 5A
ALEXANDRIA LA
71301-8421
US

V. Phone/Fax

Practice location:
  • Phone: 318-448-1249
  • Fax: 318-448-5322
Mailing address:
  • Phone: 318-448-1249
  • Fax: 318-448-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE A BRYANT
Title or Position: OFFICE MANAGER
Credential:
Phone: 318-448-1249