Healthcare Provider Details

I. General information

NPI: 1104887538
Provider Name (Legal Business Name): EMILE A BARROW JR MD A MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 MAGNOLIA CV SUITE 100
MONROE LA
71203-2372
US

IV. Provider business mailing address

3510 MAGNOLIA CV SUITE 100
MONROE LA
71203-2372
US

V. Phone/Fax

Practice location:
  • Phone: 318-364-9900
  • Fax: 318-361-0428
Mailing address:
  • Phone: 318-364-9900
  • Fax: 318-361-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPO3699
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLO11453
License Number StateLA

VIII. Authorized Official

Name: DR. EMILE ANTHONY BARROW
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 318-361-9900