Healthcare Provider Details

I. General information

NPI: 1922062322
Provider Name (Legal Business Name): JAMES ARTHUR ALTICK JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 KILPATRICK BLVD
MONROE LA
71201-5139
US

IV. Provider business mailing address

2804 KILPATRICK BLVD
MONROE LA
71201-5139
US

V. Phone/Fax

Practice location:
  • Phone: 318-387-2545
  • Fax: 318-387-2775
Mailing address:
  • Phone: 318-387-2545
  • Fax: 318-387-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number021299
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: