Healthcare Provider Details

I. General information

NPI: 1659302586
Provider Name (Legal Business Name): DRAKE ERIC BELLANGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST STE 513
BATON ROUGE LA
70817
US

IV. Provider business mailing address

500 RUE DE LA VIE ST STE 513
BATON ROUGE LA
70817-5129
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-8947
  • Fax: 225-924-8948
Mailing address:
  • Phone: 225-924-8947
  • Fax: 225-924-8948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11666R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number00017404
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: