Healthcare Provider Details

I. General information

NPI: 1063472264
Provider Name (Legal Business Name): JOHN C BEATROUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LAKEVIEW CT SUITE A
COVINGTON LA
70433-7514
US

IV. Provider business mailing address

350 LAKEVIEW CT SUITE A
COVINGTON LA
70433-7514
US

V. Phone/Fax

Practice location:
  • Phone: 985-845-2677
  • Fax: 985-867-5498
Mailing address:
  • Phone: 985-845-2677
  • Fax: 985-867-5498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number015760
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: