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NPI Code Detail

MEDICARE: DR. BRUCE ALFRED ST AMOUR JR. D.O.

MEDICARE: DR. BRUCE ALFRED ST AMOUR JR. D.O.
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
1207P00000XEmergency Medicine Physician014898MI
2207P00000XEmergency Medicine Physician0102205608VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3BS014898OTHERMIBLUE SHIELD

General Provider Information

NPI Number : 1821030040
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRUCE ALFRED ST AMOUR JR. D.O.
Provider Business Mailing Address
First Line : 200 CORPORATE BLVD
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-3870
Country : US
Telephone Number : 800-893-9698
Fax Number :
Provider Business Practice Location Address
First Line : 1900 ELECTRIC RD
Second Line :
City : SALEM
State : VA
Zip : 24153-7494
Country : US
Telephone Number : 540-776-4000
Fax Number : 540-776-4196
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 05/28/2019

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