MEDICARE: JESUS L. CHUA MD A PROFESSIONAL MEDICAL CORPORATION

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	261Q00000X	Clinic/Center	09772R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255657946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESUS L. CHUA MD A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	602 HAIFLEIGH ST
Second Line	:
City	:	FRANKLIN
State	:	LA
Zip	:	70538-3731
Country	:	US
Telephone Number	:	337-828-4037
Fax Number	:	337-828-7740

Provider Business Practice Location Address
First Line	:	602 HAIFLEIGH ST
Second Line	:
City	:	FRANKLIN
State	:	LA
Zip	:	70538-3731
Country	:	US
Telephone Number	:	337-828-4037
Fax Number	:	337-828-7740

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JESUS LAO CHUA
Credential	:	MD
Telephone Number	:	337-828-4037

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	04/20/2010

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