Healthcare Provider Details

I. General information

NPI: 1255659363
Provider Name (Legal Business Name): DR. KEITH CALHOUN, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 OLD STERLINGTON RD
MONROE LA
71203-2396
US

IV. Provider business mailing address

4400 OLD STERLINGTON RD
MONROE LA
71203-2396
US

V. Phone/Fax

Practice location:
  • Phone: 318-324-1414
  • Fax: 318-324-2120
Mailing address:
  • Phone: 318-324-1414
  • Fax: 318-324-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number024133
License Number StateLA

VIII. Authorized Official

Name: DR. BRIAN KEITH CALHOUN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 318-324-1414