MEDICARE: DR. CHARLES DEWEY BELLEAU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	MD.007948	LA

General Provider Information

NPI Number	:	1144734773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES DEWEY BELLEAU MD

Provider Business Mailing Address
First Line	:	555 HIGH LAKE DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-4334
Country	:	US
Telephone Number	:	225-766-5256
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 HIGH LAKE DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-4334
Country	:	US
Telephone Number	:	225-766-5256
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2017
Last Update Date	:	11/17/2017

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