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General NPI Number Information
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NPI Number | 1104898527
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Entity Type | Organization
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Legal Business Name | LAFAYETTE BONE & JOINT CLINIC
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 1103 KALISTE SALOOM RD SUITE 104
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City | LAFAYETTE
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State | LA
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Zip | 70508-5783
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Country | US
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Telephone | 337-289-9129
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Fax | 337-289-9131
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Provider Business Mailing Address
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Address Line | 1103 KALISTE SALOOM RD SUITE 104
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City | LAFAYETTE
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State | LA
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Zip | 70508-5783
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Country | US
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Telephone | 337-289-9129
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Fax | 337-289-9131
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN E COBB
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Credential | MD
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Telephone | 337-234-5234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 00589
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License Number State | LA
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