Healthcare Provider Details

I. General information

NPI: 1134116064
Provider Name (Legal Business Name): GEORGE JUDE BARES MD APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 AMBASSADOR CAFFERY PKWY SUITE 201
LAFAYETTE LA
70508-6926
US

IV. Provider business mailing address

PO BOX 81885
LAFAYETTE LA
70598-1885
US

V. Phone/Fax

Practice location:
  • Phone: 337-988-2345
  • Fax:
Mailing address:
  • Phone: 337-988-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE J. BARES
Title or Position: OWNER/MD
Credential: MD
Phone: 337-261-5151