MEDICARE: ROGER D LAFLEUR MS LPE

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	103T00000X	Psychologist	875E	AR

General Provider Information

NPI Number	:	1518976646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER D LAFLEUR MS LPE

Provider Business Mailing Address
First Line	:	PO BOX 72
Second Line	:
City	:	MCGEHEE
State	:	AR
Zip	:	71654
Country	:	US
Telephone Number	:	870-222-3107
Fax Number	:	870-222-6741

Provider Business Practice Location Address
First Line	:	2410 HWY 65 N
Second Line	:
City	:	MCGEHEE
State	:	AR
Zip	:	71654
Country	:	US
Telephone Number	:	870-222-3107
Fax Number	:	870-222-6741

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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