Provider Demographics
NPI:1366452807
Name:ELKINS, BRIAN LANE (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LANE
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 1:3516 NORTH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3613
Mailing Address - Country:US
Mailing Address - Phone:318-441-2220
Mailing Address - Fax:318-441-2205
Practice Address - Street 1:3516 NORTH BLVD STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3613
Practice Address - Country:US
Practice Address - Phone:318-441-2220
Practice Address - Fax:318-441-2205
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13101R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1556793Medicaid
LA1556793Medicaid
LA5E637Medicare PIN