Healthcare Provider Details

I. General information

NPI: 1194234765
Provider Name (Legal Business Name): GEORGE HOUSTON BEGLEY II HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E KALISTE SALOOM RD STE 102
LAFAYETTE LA
70508-8509
US

IV. Provider business mailing address

110 E KALISTE SALOOM RD STE 102
LAFAYETTE LA
70508-8509
US

V. Phone/Fax

Practice location:
  • Phone: 337-706-8550
  • Fax: 337-706-8559
Mailing address:
  • Phone: 337-706-8550
  • Fax: 337-706-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1178
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: