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General NPI Number Information
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NPI Number | 1881834406
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Entity Type | Organization
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Legal Business Name | MDL MED CORP LLC
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Dates
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Enumeration Date | 02/22/2009
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Last Update Date | 02/22/2009
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Provider Practice Location Address
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Address Line | 2415 STONEYBROOK
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City | LAKE CHARLES
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State | LA
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Zip | 70605-4036
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Country | US
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Telephone | 337-474-9197
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 STONEYBROOK
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City | LAKE CHARLES
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State | LA
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Zip | 70605-4036
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Country | US
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Telephone | 337-474-9197
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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. MARK D LAFURIA
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Credential | M.D.
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Telephone | 337-474-9197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | MD.200687
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License Number State | LA
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