Provider Demographics
NPI:1144243080
Name:GRIEBROK-ASSERCQ, JULE IRENE (MD)
Entity Type:Individual
Prefix:MISS
First Name:JULE
Middle Name:IRENE
Last Name:GRIEBROK-ASSERCQ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1818
Mailing Address - Country:US
Mailing Address - Phone:225-987-9013
Mailing Address - Fax:
Practice Address - Street 1:1401 NORTH FOSTER DR
Practice Address - Street 2:LSU MID-CITY DIABETIC FOOT & WOUND CLINIC
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-987-9013
Practice Address - Fax:225-987-9093
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA21163207RC0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1489611Medicaid
H27616Medicare UPIN
5H866Medicare ID - Type Unspecified
5H866DD21Medicare PIN