Healthcare Provider Details

I. General information

NPI: 1780697227
Provider Name (Legal Business Name): BRIAN KEITH CALHOUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/23/2017
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 Code207Q00000X
TaxonomyFamily Medicine Physician
License Number024133
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: