Healthcare Provider Details

I. General information

NPI: 1699762948
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL EARNHARDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MEDICAL PLAZA PL
MINDEN LA
71055-3330
US

IV. Provider business mailing address

3 MEDICAL PLAZA PL
MINDEN LA
71055-3330
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-7134
  • Fax: 318-377-7098
Mailing address:
  • Phone: 318-377-7134
  • Fax: 318-377-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number024176
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: