MEDICARE: APPLEGATE

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	101Y00000X	Counselor
2	207QA0401X	Addiction Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1437393162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLEGATE

Provider Business Mailing Address
First Line	:	1605 BENTON RD
Second Line	:	SUITE D
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3578
Country	:	US
Telephone Number	:	318-742-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 BENTON RD
Second Line	:	SUITE D
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3578
Country	:	US
Telephone Number	:	318-742-0500
Fax Number	:	318-742-0588

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	PHILIP ISHERWOOD
Credential	:	MD
Telephone Number	:	318-742-0500

Provider Enumeration Date	:	04/24/2009
Last Update Date	:	06/04/2009

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Directions to “APPLEGATE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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