Healthcare Provider Details

I. General information

NPI: 1487973475
Provider Name (Legal Business Name): JODIE ANGELA HARGUS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2010
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3149 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70506-7209
US

IV. Provider business mailing address

3149 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70506-7209
US

V. Phone/Fax

Practice location:
  • Phone: 337-706-3415
  • Fax:
Mailing address:
  • Phone: 337-706-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS12269
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number000342
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number000342
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: