Healthcare Provider Details

I. General information

NPI: 1780687822
Provider Name (Legal Business Name): CHRISTINE J INCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605B MEDICAL CENTER DR
ALEXANDRIA LA
71301-8127
US

IV. Provider business mailing address

605 MEDICAL CENTER DR STE B
ALEXANDRIA LA
71301-8145
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-2232
  • Fax: 318-442-2192
Mailing address:
  • Phone: 318-442-2232
  • Fax: 318-442-2192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number13422R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: