Healthcare Provider Details

I. General information

NPI: 1972690741
Provider Name (Legal Business Name): ALLEN LARKIN SPIRES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 DAVENPORT AVENUE
MER ROUGE LA
71261
US

IV. Provider business mailing address

301 DAVENPORT AVENUE
MER ROUGE LA
71261
US

V. Phone/Fax

Practice location:
  • Phone: 318-647-5008
  • Fax: 318-647-9956
Mailing address:
  • Phone: 318-647-5008
  • Fax: 318-647-9956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number018531
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: