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General NPI Number Information
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NPI Number | 1669669495
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Entity Type | Organization
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Legal Business Name | JEFFERSON LINER JR & DOROTHY LEWIS PTRS
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 11/05/2008
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Provider Practice Location Address
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Address Line | 120 N CATE ST
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City | HAMMOND
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State | LA
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Zip | 70401-3357
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Country | US
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Telephone | 985-542-1364
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Fax | 985-542-8679
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Provider Business Mailing Address
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Address Line | PO BOX 2308
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City | HAMMOND
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State | LA
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Zip | 70404-2308
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Country | US
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Telephone | 985-542-1364
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Fax | 985-542-8679
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LISA H FORREST
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Credential |
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Telephone | 985-542-1364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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