Healthcare Provider Details

I. General information

NPI: 1487746509
Provider Name (Legal Business Name): PHILLIP ANTHONY BARKSDALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST SUITE 511
BATON ROUGE LA
70817-5127
US

IV. Provider business mailing address

500 RUE DE LA VIE ST SUITE 511
BATON ROUGE LA
70817-5127
US

V. Phone/Fax

Practice location:
  • Phone: 225-752-3000
  • Fax: 225-752-8900
Mailing address:
  • Phone: 225-752-3000
  • Fax: 225-752-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number09178R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: