Healthcare Provider Details

I. General information

NPI: 1154318541
Provider Name (Legal Business Name): LAFAYETTE RADIOLOGY ASSOCIATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 COOLIDGE BLVD
LAFAYETTE LA
70503-2621
US

IV. Provider business mailing address

PO BOX 53127
LAFAYETTE LA
70505-3127
US

V. Phone/Fax

Practice location:
  • Phone: 337-261-7970
  • Fax:
Mailing address:
  • Phone: 337-261-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID JENKINS
Title or Position: MD PARTNER
Credential: MD
Phone: 337-261-7970