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General NPI Number Information
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NPI Number | 1942120944
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Entity Type | Individual
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Provider Name | DONOVAN LANDRY BSRS, (R)(CT)
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Gender | Male
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 524 DR MICHAEL DEBAKEY DR
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5725
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Country | US
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Telephone | 337-436-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 FENIMORE LOOP
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City | WESTLAKE
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State | LA
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Zip | 70669-5400
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Country | US
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Telephone | 337-660-7601
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C3401X
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Taxonomy Name | Computed Tomography Radiologic Technologist
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License Number | 12994
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License Number State | LA
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