Provider Demographics
NPI:1306825112
Name:STELLY, HOWARD M (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:M
Last Name:STELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 W GAUTHIER RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-7179
Mailing Address - Country:US
Mailing Address - Phone:337-477-6061
Mailing Address - Fax:337-477-3576
Practice Address - Street 1:1890 W GAUTHIER RD
Practice Address - Street 2:SUITE 155
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-7179
Practice Address - Country:US
Practice Address - Phone:337-477-6061
Practice Address - Fax:337-477-3576
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA019484207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1917770Medicaid
LA5N594C423Medicare ID - Type Unspecified
LA1917770Medicaid