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General NPI Number Information
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NPI Number | 1609002849
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Entity Type | Organization
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Legal Business Name | BATON ROUGE SPORTS MEDICINE CLINIC, LLC
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 720 CONNELLS PARK LN
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City | BATON ROUGE
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State | LA
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Zip | 70806-6522
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Country | US
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Telephone | 225-216-3047
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Fax | 225-928-7054
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Provider Business Mailing Address
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Address Line | 720 CONNELLS PARK LN
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City | BATON ROUGE
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State | LA
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Zip | 70806-6522
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Country | US
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Telephone | 225-216-3047
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Fax | 225-928-7054
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | ROBERT W DUGAS
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Credential | M.D.
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Telephone | 225-216-3047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 17260
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License Number State | LA
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