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General NPI Number Information
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NPI Number | 1215053533
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Entity Type | Organization
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Legal Business Name | STEPHENS MEDICAL ENTERPRISES, INCORPORATION
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 4004 CONVENTION ST
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City | BATON ROUGE
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State | LA
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Zip | 70806-3807
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Country | US
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Telephone | 225-267-6509
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Fax | 225-265-6522
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Provider Business Mailing Address
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Address Line | PO BOX 66239
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City | BATON ROUGE
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State | LA
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Zip | 70896-6239
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Country | US
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Telephone | 225-267-6509
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Fax | 225-265-6522
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Authorized Official
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Title or Position | PHYSICIAN
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Name | CYNTHIA AMELIA COE
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Credential | M.D.
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Telephone | 225-267-6509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 015345
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License Number State | LA
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