Healthcare Provider Details

I. General information

NPI: 1679627681
Provider Name (Legal Business Name): PHYSICIANS IN MEDICAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 COOLIDGE BLVD SUITE 1751
LAFAYETTE LA
70503-2621
US

IV. Provider business mailing address

PO BOX 52009
LAFAYETTE LA
70505-2009
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-7927
  • Fax: 337-289-7935
Mailing address:
  • Phone: 337-289-7927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT CARROLL
Title or Position: PARTNER
Credential: MD
Phone: 337-289-7927