Healthcare Provider Details

I. General information

NPI: 1467927723
Provider Name (Legal Business Name): EUGENE AND OLEANDER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11715 BRICKSOME AVE STE A6
BATON ROUGE LA
70816-2307
US

IV. Provider business mailing address

1604 LICHESTER DR
BATON ROUGE LA
70810-0503
US

V. Phone/Fax

Practice location:
  • Phone: 225-246-7136
  • Fax: 225-302-7015
Mailing address:
  • Phone: 985-226-1606
  • Fax: 225-302-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA RAI CLARK
Title or Position: OWNER
Credential: MD
Phone: 985-226-1606