Basic Information
| Provider Information | |||||||||
| NPI: | 1740530427 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENT ASSOCIATES OF NORTHEAST LOUISIANA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2802 KILPATRICK BLVD | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712015139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188556282 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2802 KILPATRICK BLVD | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712015139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188556282 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2012 | ||||||||
| LastUpdateDate: | 09/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | BARHAM | ||||||||
| AuthorizedOfficialFirstName: | WILSON | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3188556282 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.