=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881915411
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONTEMPORARY WOMENS CARE OF BREAUX BRIDGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2010
-----------------------------------------------------
Last Update Date | 06/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1546 GARY DRIVE
-----------------------------------------------------
City | BREAUX BRIDGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-289-1808
-----------------------------------------------------
Fax | 337-289-1988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1546 GARY DRIVE
-----------------------------------------------------
City | BREAUX BRIDGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-289-1808
-----------------------------------------------------
Fax | 337-289-1988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ERIC PAUL ELIAS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 337-241-1269
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 203619
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------