Healthcare Provider Details

I. General information

NPI: 1366444994
Provider Name (Legal Business Name): REAGAN ELKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 CHURCH STREET SUITE E
ZACHARY LA
70380-1850
US

IV. Provider business mailing address

2335 CHURCH ST STE E
ZACHARY LA
70791-2700
US

V. Phone/Fax

Practice location:
  • Phone: 225-654-3607
  • Fax: 225-658-2262
Mailing address:
  • Phone: 225-570-2489
  • Fax: 225-570-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number025965
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: