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General NPI Number Information
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NPI Number | 1497710792
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Entity Type | Individual
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Provider Name | ANDREA NATALIE BLAKE-MCMAHON M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 05/06/2016
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Provider Practice Location Address
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Address Line | 129 MINDEN SHOPPING DR
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City | MINDEN
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State | LA
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Zip | 71055-2770
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Country | US
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Telephone | 318-377-2007
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Fax | 318-377-3099
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Provider Business Mailing Address
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Address Line | 1007 GOULD DR STE 1
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City | BOSSIER CITY
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State | LA
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Zip | 71111-4971
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Country | US
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Telephone | 318-377-2007
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Fax | 318-377-3099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 14851R
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 14851R
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License Number State | LA
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