Provider Demographics
NPI:1467695528
Name:LUSTER, WILLIAM BAILEY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BAILEY
Last Name:LUSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71458-0488
Mailing Address - Country:US
Mailing Address - Phone:318-238-6401
Mailing Address - Fax:318-238-6402
Practice Address - Street 1:617 BIENVILLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5730
Practice Address - Country:US
Practice Address - Phone:318-238-6401
Practice Address - Fax:318-238-6402
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD.204308OtherLOUISIANA MEDICAL LICENSE
LACDS.040498-MDOtherLOUISIANA CONTROLLE AND DANGEROUS SUBSTANCES
LACDS.040498-MDOtherLOUISIANA CONTROLLE AND DANGEROUS SUBSTANCES