Healthcare Provider Details

I. General information

NPI: 1124094909
Provider Name (Legal Business Name): JOHN FLEMING JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MORRIS DR
MINDEN LA
71055-3053
US

IV. Provider business mailing address

1240 COUNTRY CLUB CIR
MINDEN LA
71055-5611
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-8260
  • Fax: 318-377-9053
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05749R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: