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General NPI Number Information
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NPI Number | 1598267262
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Entity Type | Organization
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Legal Business Name | BATON ROUGE INTERVENTIONAL PAIN MANAGEMENT LLC
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 4460 BLUEBONNET BLVD STE A
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City | BATON ROUGE
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State | LA
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Zip | 70809-9658
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Country | US
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Telephone | 225-442-3166
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 77878
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City | BATON ROUGE
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State | LA
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Zip | 70879-7878
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Country | US
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Telephone | 225-442-3166
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY S. MCDANIEL JR.
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Credential | MD
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Telephone | 225-442-3166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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