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General NPI Number Information
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NPI Number | 1508829599
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Entity Type | Organization
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Legal Business Name | ELIZABETH CLUBB, APMC
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | BLUEBONNET BLVD SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70836-1206
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Country | US
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Telephone | 225-766-7771
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Fax | 225-766-7995
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Provider Business Mailing Address
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Address Line | 4864 BLUEBONNET BLVD SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70809-9644
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Country | US
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Telephone | 225-766-7771
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Fax | 225-766-7995
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Authorized Official
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Title or Position | PRESIDENT/ SURGEON
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Name | DR. ELIZABETH ANN CLUBB
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Credential | M.D.
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Telephone | 225-766-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 11291R
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License Number State | LA
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