Healthcare Provider Details

I. General information

NPI: 1710078613
Provider Name (Legal Business Name): CLAIRE JEAN PURDOME LUELF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 SHREVEPORT; HIGHWAY 71 NORTH VA MEDICAL CENTER - ALEXANDRIA
PINEVILLE LA
71360
US

IV. Provider business mailing address

PO BOX 1145
TIOGA LA
71477-1145
US

V. Phone/Fax

Practice location:
  • Phone: 318-473-0010
  • Fax: 318-483-5036
Mailing address:
  • Phone: 225-612-7872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-3230
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: