Healthcare Provider Details

I. General information

NPI: 1992899470
Provider Name (Legal Business Name): STEPHEN GARNER ABSHIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 COOLIDGE BLVD SUITE 303
LAFAYETTE LA
70503-2636
US

IV. Provider business mailing address

1211 COOLIDGE BLVD SUITE 303
LAFAYETTE LA
70503-2636
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-6697
  • Fax: 337-232-3147
Mailing address:
  • Phone: 337-232-6697
  • Fax: 337-232-6605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD011850
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: