Healthcare Provider Details

I. General information

NPI: 1891920708
Provider Name (Legal Business Name): ST ROY FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 12TH ST
LAFAYETTE LA
70501-6224
US

IV. Provider business mailing address

PO BOX 91133
LAFAYETTE LA
70509-1133
US

V. Phone/Fax

Practice location:
  • Phone: 337-769-1095
  • Fax: 337-769-1098
Mailing address:
  • Phone: 337-769-1095
  • Fax: 337-769-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number13348R
License Number StateLA

VIII. Authorized Official

Name: DR. JOHN F STROY
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 337-769-1095