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General NPI Number Information
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NPI Number | 1982002911
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Entity Type | Organization
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Legal Business Name | AFFINITY HEALTH GROUP, LLC
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 2516 BROADMOOR BLVD
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City | MONROE
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State | LA
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Zip | 71201-2988
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Country | US
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Telephone | 318-998-0353
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Fax | 318-998-0357
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Provider Business Mailing Address
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Address Line | 130 DESIARD ST SUITE 355
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City | MONROE
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State | LA
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Zip | 71201-7319
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Country | US
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Telephone | 318-807-7875
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Fax | 318-812-6603
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MR. MIKE BREARD
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Credential |
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Telephone | 318-361-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 013918
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License Number State | LA
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