Provider Demographics
NPI:1235484189
Name:BEURLOT, MICHELLE R (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:BEURLOT
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 1:1587 N BOLTON AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-4255
Mailing Address - Country:US
Mailing Address - Phone:318-445-9823
Mailing Address - Fax:318-445-1509
Practice Address - Street 1:1587 N BOLTON AVE STE 1100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-4255
Practice Address - Country:US
Practice Address - Phone:318-445-9823
Practice Address - Fax:318-445-1509
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA322103207QG0300X, 207Q00000X
TXBP10041034390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program