Healthcare Provider Details

I. General information

NPI: 1801890751
Provider Name (Legal Business Name): RAYLAND KEVIN BEURLOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 SHREVEPORT HWY
PINEVILLE LA
71360-4044
US

IV. Provider business mailing address

PO BOX 12787
ALEXANDRIA LA
71315-2787
US

V. Phone/Fax

Practice location:
  • Phone: 184-730-0103
  • Fax: 318-445-3510
Mailing address:
  • Phone: 318-473-9050
  • Fax: 318-473-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20112
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: