Provider Demographics
NPI:1073548756
Name:NABOURS, PAUL KEITH (M D)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KEITH
Last Name:NABOURS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-2134
Mailing Address - Country:US
Mailing Address - Phone:337-474-1010
Mailing Address - Fax:337-474-1011
Practice Address - Street 1:3700 5TH AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-2134
Practice Address - Country:US
Practice Address - Phone:337-474-1010
Practice Address - Fax:337-474-1011
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA123362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA15980Medicaid
LAD04256Medicare UPIN
LA15980Medicaid