Healthcare Provider Details

I. General information

NPI: 1689709040
Provider Name (Legal Business Name): ALLEN L, SPIRES MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 DAVENPORT AVE
MER ROUGE LA
71261
US

IV. Provider business mailing address

PO BOX 429
MER ROUGE LA
71261-0429
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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLEN LARKIN SPIRES
Title or Position: OWNER-PHYSICIAN
Credential: M.D.
Phone: 318-647-5008