Provider Demographics
NPI:1366444994
Name:ELKINS, REAGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:REAGAN
Middle Name:
Last Name:ELKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 CHURCH ST STE E
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2700
Mailing Address - Country:US
Mailing Address - Phone:225-570-2489
Mailing Address - Fax:225-570-2986
Practice Address - Street 1:2335 CHURCH STREET
Practice Address - Street 2:SUITE E
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70380-1850
Practice Address - Country:US
Practice Address - Phone:225-654-3607
Practice Address - Fax:225-658-2262
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1053112Medicaid
LAI31124Medicare UPIN
LA4J639CG71Medicare PIN