Healthcare Provider Details

I. General information

NPI: 1780814756
Provider Name (Legal Business Name): BEAUREGARD PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PINE ST
DERIDDER LA
70634-4942
US

IV. Provider business mailing address

PO BOX 730
DERIDDER LA
70634-0730
US

V. Phone/Fax

Practice location:
  • Phone: 337-462-7106
  • Fax: 337-462-7479
Mailing address:
  • Phone: 337-462-7106
  • Fax: 337-462-7479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD.09850R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. JARRED VEILLON
Title or Position: CFO
Credential:
Phone: 337-462-7409