Healthcare Provider Details

I. General information

NPI: 1821067570
Provider Name (Legal Business Name): HERBERT ALDON NESOM JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 6TH AVE
OAKDALE LA
71463-2628
US

IV. Provider business mailing address

PO BOX 1140
OAKDALE LA
71463-1140
US

V. Phone/Fax

Practice location:
  • Phone: 318-335-4881
  • Fax: 318-335-4544
Mailing address:
  • Phone: 318-335-4881
  • Fax: 318-335-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number008970
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: