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General NPI Number Information
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NPI Number | 1093702367
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Entity Type | Organization
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Legal Business Name | SUNSET MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 990 NAPOLEON AVENUE
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City | SUNSET
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State | LA
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Zip | 70584-6100
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Country | US
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Telephone | 337-662-7290
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Fax |
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Provider Business Mailing Address
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Address Line | 990 NAPOLEON AVENUE
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City | SUNSET
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State | LA
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Zip | 70584-6100
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Country | US
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Telephone | 337-662-7290
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Fax |
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Authorized Official
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Title or Position | PARTNER/MD
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Name | RANDY JAMES DAIGLE
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Credential | MD
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Telephone | 337-662-7290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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