Provider Demographics
NPI:1407411838
Name:DOUBLE D HEALTH PROFESSIONALS LLC
Entity Type:Organization
Organization Name:DOUBLE D HEALTH PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:DRERUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-443-4576
Mailing Address - Street 1:3704 NORTH BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3658
Mailing Address - Country:US
Mailing Address - Phone:318-443-4576
Mailing Address - Fax:
Practice Address - Street 1:3704 NORTH BLVD STE C
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3658
Practice Address - Country:US
Practice Address - Phone:318-443-4576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty