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General NPI Number Information
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NPI Number | 1528239555
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Entity Type | Organization
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Legal Business Name | RICHARD J. BIDSTRUP, M.D. LTD.
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 4049 I 49 S SERVICE RD
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City | OPELOUSAS
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State | LA
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Zip | 70570-0757
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Country | US
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Telephone | 337-942-2674
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Fax | 337-948-1858
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Provider Business Mailing Address
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Address Line | 4049 I 49 S SERVICE RD
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City | OPELOUSAS
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State | LA
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Zip | 70570-0757
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Country | US
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Telephone | 337-942-2674
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Fax | 337-948-1858
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RICHARD J. BIDSTRUP
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Credential | M.D.
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Telephone | 337-942-2674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | L009234
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License Number State | LA
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