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NPI Code Detail

MEDICARE: DR. JOHN LIEBERT COLLIGAN M.D.

MEDICARE: DR. JOHN LIEBERT COLLIGAN M.D.
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
1207V00000XObstetrics & Gynecology Physician10207LA

Other Identifiers

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

General Provider Information

NPI Number : 1295727550
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN LIEBERT COLLIGAN M.D.
Provider Business Mailing Address
First Line : 3203 CYPRIEN LN
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70605-2254
Country : US
Telephone Number : 337-478-6361
Fax Number : 337-474-0628
Provider Business Practice Location Address
First Line : 2000 OPELOUSAS ST
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-2641
Country : US
Telephone Number : 337-439-9983
Fax Number : 337-437-9460
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 07/28/2008

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