Healthcare Provider Details

I. General information

NPI: 1407411838
Provider Name (Legal Business Name): DOUBLE D HEALTH PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 NORTH BLVD STE C
ALEXANDRIA LA
71301-3658
US

IV. Provider business mailing address

3704 NORTH BLVD STE C
ALEXANDRIA LA
71301-3658
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-4576
  • Fax:
Mailing address:
  • Phone: 318-443-4576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. M LAWRENCE DRERUP
Title or Position: MANAGER
Credential: MD
Phone: 318-443-4576