Provider Demographics
NPI:1063472264
Name:BEATROUS, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:BEATROUS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:350 LAKEVIEW CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7514
Mailing Address - Country:US
Mailing Address - Phone:985-845-2677
Mailing Address - Fax:985-867-5498
Practice Address - Street 1:350 LAKEVIEW CT
Practice Address - Street 2:SUITE A
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7514
Practice Address - Country:US
Practice Address - Phone:985-845-2677
Practice Address - Fax:985-867-5498
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA015760207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1348368Medicaid
LAB61971Medicare UPIN
LA1348368Medicaid
LA5M722CY79Medicare PIN