Provider Demographics
NPI:1275706574
Name:JANICE R. PHARR, MD, LLC
Entity Type:Organization
Organization Name:JANICE R. PHARR, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:PHARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-323-0362
Mailing Address - Street 1:1825 N 18TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4401
Mailing Address - Country:US
Mailing Address - Phone:318-323-0362
Mailing Address - Fax:318-323-0567
Practice Address - Street 1:1825 N 18TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4401
Practice Address - Country:US
Practice Address - Phone:318-323-0362
Practice Address - Fax:318-323-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD015992261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1445274Medicaid